高血压患者阻塞性睡眠呼吸暂停低通气综合征与冠状动脉狭窄性病变的关系研究

Correlation between Obstructive Sleep Apnea Hypopnea Syndrome and Coronary Artery Stenosis in Patients with Hypertension

目的探讨高血压患者阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与冠状动脉狭窄性病变的关系。方法选择2007—2012年在航空总医院和南华大学第一附属医院行冠状动脉造影检查的高血压患者172例,根据Phillipson EA标准分为OSAHS阳性组和OSAHS阴性组,每组86例。比较两组患者冠状动脉病变支数、Gensini积分、颈动脉内膜中层厚度(IMT)及血清纤溶酶原激活物抑制因子1(PAI-1)、细胞间黏附分子1(ICAM-1)、内皮素1(ET-1)水平。结果 OSAHS阴性组患者经冠状动脉造影确诊冠心病49例(OSAHS阴性合并冠心病组),OSAHS阳性组患者确诊冠心病67例(OSAHS阳性合并冠心病组),OSAHS阳性组患者冠心病发生率高于OSAHS阴性组。OSAHS阳性合并冠心病组冠状动脉病变程度重于OSAHS阴性合并冠心病组,Gensini积分大于OSAHS阴性合并冠心病组(P<0.01)。OSAHS阳性组患者颈动脉IMT大于OSAHS阴性组,血清PAI-1、ICAM-1、ET-1水平高于OSAHS阴性组(P<0.01)。结论高血压合并OSAHS患者冠心病发生率较高,合并冠心病者冠状动脉狭窄性病变程度较重,炎性反应在动脉粥样硬化的发生和发展过程中起重要作用。

Objective To explore the correlation between obstructive sleep apnea hypopnea syndrome（ OSAHS） and coronary artery stenosis in patients with hypertension. Methods From 2007 to 2012,a tatal of 172 patients with hypertension were selected in Aviation General Hospital and the First Affiliated Hospital of Nanhua University,and they were divided into groups A（ with OSAHS） and B（ without OSAHS） according to Phillipson EA standard. Number of stenosed coronary vessels, Gensini score,IMT of carotid artery and serum levels of PAI-1,ICAM-1,ET-1 between the two groups were compared. Results In group A,67 cases checked out of coronary heart disease（A subgroup）,49 cases in group B（B subgroup）. The incidence of coronary heart disease in group A,severity of coronary artery and Gensini score in A subgroup were significantly higher than those in group B and B subgroup（P﹤0. 05）. The IMT of carotid artery and serum levels of PAI-1,ICAM-1, ET-1 of group A were significantly higher than those of group B（P﹤0. 01）. Conclusion The incidence of coronary heart dis-ease is higher,severity of coronary artery is more serious in hypertension patients associated with OSAHS,and inflammatory re-action has important effect on atherosclerosis.