阻塞性睡眠呼吸暂停低通气综合征对青年高血压患者左心室结构、颈动脉IMT和baPWV的影响

Effect of obstructive sleep apnea-hypopnea syndrome on left ventricular structure, carotid artery IMT and baPWV in young patients with essential hypertension

目的探讨青年人群阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)和原发性高血压(essential hypertension,EH)之间的关系以及OSAHS对青年EH患者左心室结构和功能、颈动脉内中膜厚度(intima-media thickness,IMT)和肱-踝脉搏波传导速度(brachial-ankle pulse wave conduction velocity velocity,ba PWV)的影响。方法选择EH并OSAHS青年患者92例,设为EH+OSAHS组,选择同期住院治疗的单纯EH青年患者104例,设为EH组。对两组基本资料、生化指标、颈动脉IMT、左心室超声心动图检查结果和ba PWV进行对比分析,比较两组的差异。结果 (1)EH+OSAHS组腰臀比、体质量指数及血清空腹血糖、总胆固醇、三酰甘油、低密度脂蛋白胆固醇和尿酸浓度均高于EH组,差异均有统计学意义(P<0.05);EH+OSAHS组收缩压、舒张压均明显高于EH组,差异均有统计学意义(P<0.05),舒张压升高更为明显;EH+OSAHS组血清高密度脂蛋白胆固醇浓度低于EH组,但差异无统计学意义(P>0.05)。(2)EH+OSAHS组左心室后壁厚度、舒张末期左心室内径、舒张末期室间隔厚度、左心室质量指数较EH组均增高,差异均有统计学意义(P<0.05),左心室质量指数的增高更为明显;EH+OSAHS组颈总动脉和颈内动脉IMT较EH组增厚,差异均有统计学意义(P<0.05);EH+OSAHS组颈动脉分叉IMT略高于EH组,但差异无统计学意义(P>0.05);EH+OSAHS组和EH组ba PWV均有增高,但EH+OSAHS组增高更为明显,两组比较差异有统计学意义(P<0.05)。结论 OSAHS既是青年EH患者的EH形成的危险因素,也是左心室结构和功能改变以及颈动脉IMT增厚、ba PWV加快等动脉粥样硬化和靶器官损害的重要影响因素。

Objectives To investigate the relationship between obstructive sleep apnea-hypopnea syndrome（OSAHS）and essential hypertension（EH） in young people, as well as the effect of OSAHS on left ventricular structure and function,carotid artery intima-media thickness（IMT） and brachial-ankle pulse wave conduction velocity（ba PWV） in young patients with EH. Methods Ninety-two youths with EH combined with OSAHS were set into EH ＋OSAHS group, and104 youths with simple EH were set into EH group in the same period. Basic data, biochemical indexes, carotid artery IMT, left ventricular echocardiographic results and ba PWV were compared between the two groups. Results（1） Waisthip ratio, body mass index, fasting blood glucose, cholesterol, triglycerides, low-density lipoprotein cholesterol, uric acid, systolic and diastolic pressures were significantly higher in EH＋OSAHS group than those in EH group（P〈0.05）,and diastolic pressure increased more significantly（P〈0.05）. High-density lipoprotein cholesterol was lower in EH ＋OSAHS group than that in EH group, but it had no significant difference（P〉0.05）.（2）Left ventricular posterior wall thickness（LVPWT）, left ventricular end-diastolic dimension（LVEDd）, interventricular septal thickness（IVST）, left ventricular mass index（LVMI） in EH ＋OSAHS group were significantly higher than those in the EH group（P〈0.05）,and LVMI increased more obviously; common carotid artery and carotid artery IMT in EH＋OSAHS group were obviously thicker than those in EH group（P〈0.05）; carotid bifurcation IMT in EH＋OSAHS group was slightly higher than that in EH group, but it had no significant difference（P〉0.05）; ba PWV increased both in EH＋OSAHS group and EH group,and it increased more significantly in EH ＋OSAHS group, the difference between the two groups was significant（P〈0.05）. Conclusions OSAHS is the risk factor of the formation of EH in youths. It is also the important influence factor for changes in left ventricular structure and function, thickening carotid artery IMT and acceleration of ba PWV.