以舌后区阻塞为主的睡眠呼吸暂停低通气综合征患者颏舌肌病理形态的电镜观察

Pathologic changes of the genioglossus in patients with obstructive sleep apnea hypopnea syndrome dominated by lingual region obstruction

目的:研究以舌后区阻塞为主的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的颏舌肌在透射电镜下的病理形态学改变,并探讨其在OSAHS发病机制中的作用及临床意义。方法:选取接受舌体部分切除术及UPPP治疗的OSAHS患者38例,根据AG监测的AHI值将患者分为轻-重度组(30<AHI≤45,10例)、中-重度组(45<AHI≤60,13例)和重-重度组(AHI>60,15例)。对照组为6例无口咽及喉咽部阻塞疾病的成人患者。透射电镜下观察颏舌肌形态变化特点。结果:透射电镜下对照组的颏舌肌组织肌纤维排列规整,肌间线粒体形状规则;所有OSAHS患者的颏舌肌标本都同时存在以下3种变化:轻度变化肌纤维萎缩、排列稀松,间隙增大,局部肌丝水肿,肌束间结缔组织增生,线粒体肿胀,部分呈球形,嵴尚清晰;中度变化肌纤维明显萎缩,直径大小不一,排列紊乱,Z线距离缩短、扭曲,部分肌丝断裂、溶解消失,肌束间结缔组织明显增生,线粒体肿大呈空泡样变性,嵴模糊、变短及形态不规则;重度变化肌纤维大量断裂、溶解,排列紊乱,凝集成团块状,呈点状或片状排列,Z线扭曲消失,线粒体大小不一,呈空泡样变性,嵴消失,有的呈絮状改变,部分样本可见线粒体堆积现象。且随AHI的增高,轻度变化出现比率降低,重度变化出现比率则升高。结论:OSAHS患者颏舌肌及线粒体的改变是一个连续、渐进的过程,且随OSAHS程度加重,舌体颏舌肌组织病理形态学变化有逐渐加重的趋势。

Objective： To study the pathological changes of genioglossus with transmission electron microscope （TEM） in patients with obstructive sleep apnea hypopnea syndrome （OSAHS） dominated by lingual region ob- struction, and to explore the role of tongue organizations in the pathogenesis and its clinical significance.Method： Thirty-eight cases of genioglossus were collected from the patients received UPPP and partial glossectomy （30〈AHI≤45 mild group 10 cases; 45〈AHI≤60,moderate group 13 cases; AHI^60 severe group 15 cases）, 6 adult patients without oropharyneal and hypopharyneal obstructive disease received tongue tumor resection or trau- ma debridement surgery were collected as control group. The features of morphological changes in genioglossus were observed by TEM. Resnlt： Under the TEM, in the control group, the muscle fibers of the genioglossus organi- zation arranges regular, mitochondrial shape between muscle was regular;The below 3 kinds of variations existed simultaneously in all genioglossus specimens of all the OSAHS patients. In the mild group, myofibrillar atrophied, arranged sloppily, the gap was increased, localized filaments were edema, connective tissue between muscle bun- dles was proliferated, mitochondria were swelling, some were spherical, crests were still clear; In the moderate group, myofibrillar obviously atrophied with different diametric sizes and disorderliness, the Z lines were short- ened or distorted, part of the myofibrillar ruptured, dissolved or disappeared, the connective tissues between mus- cle bundles were obviously proliferated, mitochondria were swellen, vacuolar degeneration, crests were vague, shorten and irregulatiol In the severe group, a large number of myofibrillar were fractured, dissolved, disorgan- ized, integrated condensate lumpy, spotty or flake arranged, Z-lines were distorted or disappeared. Mitochondria were sizes, showed vacuolar degeneration, crests were disappeared, some changes were flocculent, mitochondria accumulation phenomenon was visible in some samples. Moreover, with the AHI increased, the occurence ratio of mild changes was decreased while severe changes occurence ratio increased. Conclnsion： The changes of genioglos- s us and mitochondrial in OSAHS patients is a continuous, progressive process, moverover, with the aggravation of OSAHS, genioglossus histopathological changes had gradually worsening tendency.