阻塞性睡眠呼吸暂停低通气综合征患者血清细胞因子水平变化与高血压的关系研究

Relationship between Hypertension and Serum Cytokines in the Patients with Obstructive Sleep Apnea Hypopnea Syndrome

目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者核因子-κB(NF-κB)和细胞间黏附分子1(ICAM-1)水平变化与高血压的关系及发病机制。方法选取与观察组年龄、体质量相匹配的健康对照者40例,经多导睡眠图确诊的单纯OSAHS患者20例,OSAHS合并高血压患者20例,比较3组间血压及NF-κB、ICAM-1水平;选取OSAHS合并高血压组中自愿接受持续气道内正压通气(CPAP)呼吸机治疗者10例进行6个月的治疗,比较患者治疗前后的血压及NF-κB、ICAM-1水平。结果治疗前健康对照组、单纯OSAHS组、OSAHS合并高血压组NF-κB值分别为(16.13±8.03)‰、(101.74±57.48)‰和(171.55±37.40)‰,差异有统计学意义(P<0.001);ICAM-1值分别为(453.53±67.14)‰、(623.90±99.43)‰和(733.67±63.30)‰,差异有统计学意义(P<0.05)。10例接受呼吸机治疗者6个月后血压、NF-κB、ICAM-1水平均明显下降,治疗前血压为(139±10)/(87±9)mm Hg,治疗后为(116±11)/(71±9)mm Hg,差异有统计学意义(P<0.01);治疗前NF-κB值为(168.67±32.92)‰,治疗后为(129.44±28.34)‰;治疗前ICAM-1值为(691.40±30.78)‰、治疗后为(648.95±52.43)‰。OSAHS患者晨醒后血压明显增高,单纯OSAHS组与OSAHS合并高血压组NF-κB和ICAM-1水平均增高,且OSAHS合并高血压组增高程度大于单纯OSAHS组,差异有统计学意义(P<0.05)。结论 OSAHS患者存在NF-κB活性改变和ICAM-1表达增强,且与OSAHS的严重程度有关;CPAP治疗可降低OSAHS合并高血压患者的血压,改善患者NF-κB活性和ICAM-1水平。

Objective To study the pathogenesis of obstructive sleep apnea hypopnea syndrome （OSAHS） and the relationships between hypertension and changes of NF - KB and ICAM - 1 in OSAHS patients. Methods Forty healthy persons in matched age and body mass index （BMI） were recruited as the controls, twenty patients diagnosed as simple OSAHS by poly- sonmograshy （PSG） test and twenty complicated OSAHS associated with hypertension. NF - KB, ICAM - 1 and the blood pres-sure were compared among three groups. Ten from complicated OSAHS patients volunteered to receive CPAP ventilator curing for six months. The blood pressure, NF - KB and ICAM - 1 levels before and after treatment were compared. Results Compared with the controls （ 16. 13 ± 8.03 ）%v, NF - KB in simple OSAHS group and OSAHS plus hypertension group were （ 101.74 ± 57.48 ）%c and （ 171.55 ±37.40）‰ respectively and the difference was significant （P 〈 0. 001 ） . The ICAM - 1 in controls, simple OSAHS and complicated OSAHS were （453.53±67.14）‰, （623.90±99. 43）‰ and （733.67±63.30）‰respective- ly and the difference was significant （P 〈 0.05 ） . The 10 patients treated with CPAP for six month had a decrease in blood pres- sure, NF- KB and ICAM -1 significantly, the blood pressure before and after CPAP ventilator treatment were （139±10） / （87±9） mmHgand （116±1l） / （71 ±9） mm Hg （P〈0.01）, NF-KB were （168.67 ± 32. 92 ） ‰ and （129.44± 28.34） %0, ICAM - 1 were （691.40 ± 30.78 ） %0 and （ 648.95 ± 52.43 ）‰ （ P 〈 0.05 ） and the differences were all signifi- eant（ P 〈 0.05 ） . The study showed that the blood pressure of patients with OSAHS was significantly higher after waking up in the morning. NF- KB and CAM - 1 were increased significantly in simple OSAHS group and complicated OSAHS group, and those in the latter group were even more higher and the difference was significant （ P 〈 0. 05 ） . Conclusion The activity change of NF - KB and the expression of ICAM - 1 being strengthened existed in OSAHS patients, which were related to the severity of OSAHS. Treatment with CPAP eould decrease the blood pressure and improve the activity of NF - KB and ICAM - 1 level in pa- tients with OSAHS plus hypertension.