阻塞性睡眠呼吸暂停综合征与血管内皮功能障碍的相关性研究

STUDY ON THE CORRELATION BETWEEN OSAS AND VASCULAR ENDOTHELIAL DYSFUNCTION

目的探讨阻塞性睡眠呼吸暂停综合征(OSAS)发生的相关因素,观察OSAS对血管内皮功能的影响,从而探讨OSAS增加心血管事件的可能机理。方法选择通过多导睡眠图测定诊断为OSAS的患者,测定其颈围、腹围、血糖、血脂、血压、体重指数(BMI)、呼吸暂停紊乱指数(AHI);对OSAS发生的相关因素进行分析,并与对照组进行比较。结果OSAS组与对照组一般临床资料比较,两组间sBP、dBP、TG、BMI、腹围、颈围存在显著性差异。OSAS组中,AHI与颈围、体重指数、甘油三脂等显著相关,与收缩压、舒张压亦有显著相关。与对照组比较,两组间右室Dd、室间隔存在显著性差异(p<0.05)。肺动脉Ds差异十分显著(p<0.01)。两组间基础肱动脉内径无显著性差异,反应性充血后内径变化率存在显著性差异、服用硝酸甘油后血管内径变化率差异十分显著。肱动脉内径变化率相关分析,结果显示其与年龄、体重指数、颈围、甘油三脂、舒张压及收缩压等均呈负相关。结论肥胖(高BMI、腹围、颈围值)与OSAS发病相关;高血压、高甘油三脂血症与OSAS间存在较好的相关性。OASA患者存在右室、肺动脉扩大,室间隔增厚。OSAS患者存在内皮介导的动脉舒张功能受损,并与年龄、体重指数、颈围、甘油三脂、舒张压及收缩压等相关。

Objective To explore the relative factors of OSAS occurrence, measure the basic clinical data of patients with OSAS, and compare with the results of control group. To investigate the affect of OSAS on endothelial function, the aim is to have a better understand of the role of OSAS in cardiovascular diseases and likely mechanism. Methods To examine polysomnography（PSG） in the snore persons. Measure the basic clinical data such as neck perimeter, abdomen perimeter, BMI, blood pressure, blood glucose, triglyceride（TG）, cholesterol, to analyze relative factors of OSAS occurrence, and compare above data with control groups＇. With color doppler ultrasongraph, to measure OSAS patients＇ heart, carotid and humeral artery inner diameter, after reactive hyperaemia and nitroglycerin administration, humeral artery inner diameter, calculate inner diameter change rate, compare with the results of control group, to explore its main affect and evaluate endothelial function in patients with OSAS. Results Compared basic clinical data between OSAS group with control group, OSAS group have a significant increasing sBP, dBP, TG, BMI, abdomen perimeter, neck（jugular） perimeter. In the OSAS group, patients＇AHI was correlated with neck（jugular） perimeter, BMI, TG, sBP, dBP, correlative coefficients were 0. 398, 0.431, 0.490, 0.413,0.44 respectively. Compared with control group, OSAS group had a increasing right ventricular Dd, IVS, pulmonary artery diameter. Between two groups, there were no significant difference on basic brachial artery （humeral artery ） inner diameter, but were significant difference of inner diameter change rate in two groups after reactive hyperaemia and nitroglycerin administration. The main factors affect humeral artery inner change rate were age, BMI, jugular perimeter, TG, sBP, dBp, were correlative coefficient. Conclusion OSAS impair patients＇ endothelial function, and related to age, BMI, jugular perimeter, TG, sBP, dBp. Obesity （increasing BMI, abdomen perimeter, jugular perimeter） is related to OSAS＇ pathogenesis, hypertension and high TG are related to the disease. AHI was correlated with neck（jugular） perimeter, BMI, TG, sBP, dBp. OSAS group had a increasing right ventricular Dd, IVS, pulmonary artery diamcter.