睡眠呼吸暂停低通气综合征并发高血压患者血浆肾素、血管紧张素Ⅱ、醛固酮水平相关性研究

Study on the association of plasma rennin angiotensin,angiotensin Ⅱ and aldosterone in sleep apnea hypopnea syndrome patients with hypertension

目的：探讨睡眠呼吸暂停低通气综合征（SAHS）患者的临床特征、血浆肾素（PRA）、血管紧张素Ⅱ（Ang Ⅱ）、醛固酮（Aldo）水平及其与高血压的相关性。方法选取行睡眠监测的患者，根据监测指标呼吸暂停低通气指数（AHI）分为180例 SAHS 患者（SAHS 组）和175例非 SAHS 患者（非 SAHS 组），比较两组的基本资料，用放射免疫法测定 PRA、AngⅡ及 Aldo 水平，采用 Spearman 等级偏相关分析进行舒张压（DBP）、收缩压（SBP）与 AHI 之间关系的分析。结果两组性别构成差异有统计学意义（χ^2＝16．30，P ＜0．01）。两组年龄、BMI、颈围、腰围、SBP、DBP 比较，SAHS 组明显高于非 SAHS 组，差异均有统计学意义（t ＝6．84、8．19、9．84、6．63、7．08、5．45，均 P ＜0．01）。SAHS 组高血压患病率为46．58％，高于非 SAHS 组的18．20％，差异有统计学意义（χ^2＝46．71，P ＜0．01）。SBP、DBP 与 AHI 呈正相关，差异均有统计学意义（rs ＝0．1620、228，均P ＜0．01）。SAHS 组患者的 PRA、AngⅡ水平低于非 SAHS 组，而其 Aldo 水平高于非 SAHS 组，差异均有统计学意义（F ＝15．41、14．21、17．67，均 P ＜0．01）。SAHS 组组间比较，高血压组的 PRA、AngⅡ水平低于非高血压组，而其 Aldo 水平高于非高血压组，差异均有统计学意义（F ＝15．41、14．21、17．67，均 P ＜0．01）。SAHS 合并高血压组的 PRA、AngⅡ水平低于单纯高血压组，而其 Aldo 水平高于后者，差异均有统计学意义（F ＝15．41、14．21、17．67，均 P ＜0．01）。结论性别、年龄、BMI、颈围、腰围、高血压等因素复合影响阻塞性睡眠呼吸暂停的发生；在 SAHS 的各系统并发症中，高血压的发病率最高；SBP、DBP 与 AHI 呈显著正相关，AHI 越高的 SAHS 患者，其患高血压的风险越大；SAHS 并发高血压患者具有血浆 Aldo 水平明显升高，PRA、AngⅡ水平明显下降的特点。

Objective To explore the clinical characteristic,level of plasma renin angiotensin （PRA）,plas-ma angiotensin Ⅱ（Ang Ⅱ）and plasma aldosterone（Aldo）in the sleep apnea hypopnea syndrome （SAHS）patients, and to investigate the association between SAHS and hypertension.Methods The patients were selected for the study who were monitored with polysomnography.They were divided into SAHS group and non-SAHS group according to apea-hypopnea index（AHI）,and there were 180 patients in the SAHS group,175 patients in the non-SAHS group. The systolic blood pressure（SBP）,diastolic blood pressure（DBP）and the level of PRA,plasma Ang II and plasma Aldo were compared by variance analysis.Results The gender composition was different between the two groups,and had statistically significant difference（χ^2 =16.30,P 〈0.01）.The data of age,body mass index,neck circumference, waistline,DBP,SBP in SAHS group were significantly higher than those in non-SAHS group,and the differences were statistically significant（t =6.84,8.19,9.84,6.63,7.08,5.45,all P 〈0.01 ）.The prevalence of hypertension in SAHS group was 46.58%,which was higher than 18.20% in non-SAHS group,and the difference had statistically significant（χ^2 =46.71,P 〈0.01）.The AHI had positive correlation with SBP,DBP,and they had statistically signifi-cant differences （rs =0.162,0.228,all P 〈0.01）.The levels of PRA and plasma Ang Ⅱ were lower in SAHS group than those in non-SAHS group,while the level of plasma Aldo was higher in SAHS group than that in non-SAHS group,and had statistically significant differences（F =15.41,14.21,17.67,all P 〈0.01）.In the SAHS group,the levels of PRA and plasma Ang Ⅱ were lower in hypertension group than those in non-hypertension group,while the level of plasma Aldo was higher in hypertension group than that in non-hypertension group,and had statistically signif-icant differences （F =15.41,14.21,17.67,all P 〈0.01）.Also,the levels of PRA and plasma Ang Ⅱ were lower in SAHS group with hypertension than those in non-SAHS group with hypertension,while the level of plasma Aldo was higher in SAHS group with hypertension than that in non-SAHS group with hypertension,and the differences were sta-tistically significant（F =15.41,14.21,17.67,all P 〈0.01）.Conclusion The occurrence of SAHS is correlated with the gender composition,age,body mass index,neck circumference,waistline,DBP and SBP.In SAHS complica-tions in each system,the highest incidence is hypertension.And the AHI has positive correlation with SBP,DBP,and the difference is significant.In the SAHS group,if the AHI is higher,the risk of hypertension is greater.In the SAHS patients with hypertension,the level of plasma Aldo is significantly elevated,while the levels of PRA and plasma AngⅡ are decreased significantly.