OSAHS合并高血压患者血浆同型半胱氨酸水平相关研究

Study on plasma homocysteine level in obstructive sleep apnea hypopnea syndrome combined with hypertension patients

目的通过观察阻塞型睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)及OSAHS合并高血压对血浆同型半胱氨酸(homocysteine,HCY)水平的影响,探讨血浆HCY水平与OSAHS严重程度及血压的相关性。方法选择115例无其他基础疾病的住院或门诊患者,将所有研究对象根据有无OSAHS及高血压分成3组:单纯鼾症(血压正常)组19例,OSAHS血压正常组55例,OSAHS合并高血压组41例,经整夜多导睡眠监测(PSG)后晨起测定空腹血浆HCY水平,将检测结果与睡眠呼吸监测指标进行相关性分析。结果 3组之间HCY水平比较,OSAHS合并高血压组最高,OSAHS血压正常组次之,单纯鼾症组最低,差异有统计学意义(P<0.01)。采用Spearman相关分析研究OSAHS严重程度与HCY水平的相关性:HCY水平随着AHI、LAT、SLT90%、呼吸暂停总次数增加而升高(P<0.01),随着LSa O2降低而升高,说明HCY水平与OSAHS严重性存在正相关,但尚不能说明HCY水平与MSa O2、睡眠效率相关(P>0.05)。进行多重线性回归分析显示:AHI和呼吸暂停总次数与HCY较其他变量具有更显著的线性回归关系,对HCY水平影响最大,差异有统计学意义(P<0.05)。结论血压与HCY水平存在正相关,提示高HCY血症可能是高血压的一种独立危险因素。随着OSAHS睡眠呼吸紊乱程度加重,血浆HCY浓度升高,检测HCY水平可以作为预测OSAHS严重程度的辅助指标。

Objective To observe the influence of obstructive sleep apnea hypopnea syndrom （OSAHS） and OSAHS combined with hypertension on plasma homocysteine （HCY） level, discuss the correlation of HCY and the severity of OSAHS and blood pressure. Methods 115 cases without other basic diseases were divided into 3 groups according to the presence of OSAHS and hypertension： 19 cases in pure sleep apnea （normal blood pressure） group, 55 cases in OSAHS and normal blood pressure group, and 41 cases in OSAHS with hypertension group. The correlation of plasma HCY levels and the results with sleep apnea monitoring index by using all night polysomnography（PSG） were analysed. Results The levels of HCY from high to low were OSAHS combined with hypertension group, OSAHS and normal blood pressure group and pure sleep apnea group. The difference was statistically significant （P〈0.01）. Spearman correlation analysis was carried out to study the correlation be-tween OSAHS severity and HCY levels： HCY levels increased with the increase of AHI, LAT, SLT90% and the total of apnea （P〈0.01） and the decrease of LSaO2, HCY level was positively correlated with OSAHS severity, but couldn＆#39;t explain the HCY associated with MSaO2 and sleep efficiency （P〉0.05）. Multiple linear regression analysis showed that apnea total number and AHI had more remarkably relationship than other variable with HCY level, the difference was statistically significant （P〈0.05）. Conclusion Blood pressure is positively correlated with HCY, the high HCY levels may be an independent risking factor of hypertension. With sleep-related breathing disorder degree of OSAHS aggravating, the plasma HCY level elevates, detection of HCY levels can predict the severity of OSAHS as auxiliary index.