阻塞性睡眠呼吸暂停对高血压患者血管内皮影响研究

Effect of obstructive sleep apnea syndrome on patients with essential hypertension

目的回顾性分析高血压合并阻塞性睡眠呼吸暂停综合征（OSAS）患者的预后及影响因素。方法对2004年1月至2007年10月江苏省省级机关医院确诊的高血压病患者共168例，通过电话和门诊随访，随访时间中位数35个月。根据多导睡眠仪监测结果分为：高血压合并OSAS（OSAS^＋）组和高血压不合并OSAS（OSAS^-）组。所有患者均通过彩色多普勒超声测定肱动脉血流介导的舒张功能（FMD），并测定与高血压预后相关的血清生化指标。随访患者心血管死亡、心绞痛或心肌梗死、脑卒中等事件。结果OSAS^＋组患者血清超敏C反应蛋白（hsCRP）水平高于OSAS^-组，（2．49±2．65）mmol／L vs（1．73±1．76）mmol／L（P〈0．05），FMD值低于OSAS^-组，（6．20±3．40）％vs（8．39±3．86）％（P〈0．05）。OSAS^＋组患者总事件发生率高于OSAS^-组（28．8％vs 13．7％，P=0．016）。Logistic多因素回归分析显示：FMD主要损伤因素排名首位是0SAs（OR=2．89，P=0．003），其次是血清hsCRP（OR=1．23，P=0．044）；FMD、血清hsCRP及尿酸成为高血压患者预后的影响因子（OR=1．7，1．7，3．5，P=0．03，0．00，0．01）。结论OSAS影响高血压患者血管内皮功能，使总的事件（心脑血管原因导致的死亡、心绞痛或心肌梗死和脑卒中）发生率增加。OSAS可能主要通过损伤血管内皮功能间接影响高血压患者的预后。

Objective This retrospective study was conducted to evaluate the prognosis of obstructive sleep apnea syndrome（OSAS） on patients with essential hypertension（EH）. Methods Follow-up was made on 168 patients with EH associated with OSAS （OSAS＋ group） or not（OSAS- group） according to the examination of polysomnography. In all patients, serum biochemical indicators and flow-mediated dilation （FMD） of the brachial artery high-resolution ultrasound technique were assessed. Cardiovascular events （cardiovascular death, angina pectoris or myocardial infarction, and ischemic stroke） served as outcome variables over a follow-up period of 35 months（median） were evaluated. Results The levels of high sense C reactive protein（hsCRP） and FMD were （2.49±2.65） mmol/L and （6.20±3.40）%in OSAS＋ group,and those were （1.73±1.76） mmol/L and （8.39±3.86）% in OSAS- group （P〈0.05,respectively）. The rate of cardiovascular evets was higher in OSAS＋ group compared with that of OSAS- group （28.8% vs 13.7%, P = 0. 016）. By multivariate logistic regression, OSAS and serum hsCRP were the significant （ OR = 2.89, P =0. 003; OR=1.23, P = 0. 044, respectively） independent risk factors for FMD; FMD, serum hsCRP and UA were influential factors for the prognosis of patients with EH （ OR =1.7,1.7,3.5, P = 0. 03,0. 00,0. 01,respectively）. Conclusions Patients of EH with OSAS have a higher rate of all events and a further damaged edothelium function,by which OSAS could contribute to the prognosis of EH patients.