阻塞性睡眠呼吸暂停低通气综合征降低原发性醛固酮增多症患者的醛固酮肾素活性比值

Obstructive sleep apnea hypopnea syndrome decreases aldosterone-rennin activity ratio value of patients with primary aldosteronism

目的探索阻塞性睡眠呼吸暂停低通气综合征(OSAHS)对原发性醛固酮增多症(PA)患者醛固酮肾素活性比值(ARR)的影响。方法回顾性分析PA患者130例,根据多导睡眠监测结果将其分为OSAHS-PA患者31例和单纯PA患者99例,比较两组患者的基线资料,采用Spearman相关分析法分析OSAHS-PA患者的ARR与睡眠呼吸紊乱指数(AHI)、最低血氧饱和度(SaO2)之间的相关性,并采用多元线性回归分析ARR值的主要影响因素。结果 OSAHS-PA组男性构成比、体质量指数、舒张压、低密度脂蛋白胆固醇、血浆肾素活性均大于单纯PA组(均P<0.05),而年龄[42(37,46)比47(41,55)岁]、ARR{539(214,1061)比1162(549,2236)(pmol/L)/[μg/(L·h)]}明显低于单纯PA组(均P<0.05);Spearman相关性分析显示OSAHS-PA患者ARR平方根与AHI呈负相关(r=-0.39,P=0.03),而与最低SaO2呈正相关(r=0.37,P=0.04);多元线性回归分析表明男性、OSAHS是ARR平方根的主要影响因素(均P<0.05)。结论 OSAHS降低PA患者ARR值;用ARR进行PA筛选时,应格外留意避免OSAHS-PA的漏诊。

Objective To explore the effects of obstructive sleep apnea hypopnea syndrome （OSAHS） on the aldo- sterone-renin activity ratio （ARR） of primary aldosteronism （PA） patients. Methods Clinical data of 130 PA pa- tients were analyzed retrospectively. The PA patients were divided into OSAHS-PA group （n= 31） and simple PA group （n= 99 ） according to the results of polysomnography examination. Baseline data of the two groups were compared. Spearman correlation analysis was used to analyze the correlations of apnea hypoventilation index （AHI） and the lowest oxygen saturation { SaO2 ） with ARR value. Multiple linear regression was used to analyze the main influence factors of ARR. Results The constituent ratio of male, body mass index （BMI）, diastolic blood pres- sure, low-density lipoprotein cholesterol （LDL-C） and plasma renin activity （PRA） in OSAHS-PA group were high- er than those in simple PA group { all P〈0.05 ） while age [42 （ 37, 46 ） vs 47 （41, 55 ） years old] and ARR{ 539 （214, 1061） vs 1162（549, 2236） （pmol/L）/l-/xg/（L · h）-]} in OSAHS-PA group were lower （all P〈0.05）. Spearman correlation analysis showed that there was a negative correlation between AHI and square root of ARR （r=- 0.39, P= 0.03） and a positive correlation between lowest SaO2 and square root of ARR （r= 0.37, P= 0.04）. Multivariate linear regression showed that male and OSAHS were the main influence factors of square root of ARR{all P% 0.05 ）. Conclusion OSAHS decreases ARR value of patients with PA. More attention should be paid to avoiding the missed diagnosis of the OSAHS-PA when ARR were used to screen patients with PA.