阻塞性睡眠呼吸暂停低通气综合征伴高血压血清诱导型一氧化氮合成酶水平临床研究

Research of serum inducible nitric oxide synthase level in patients with obstructive sleep apnea hypopnea syndrome combined with hypertention

目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并高血压患者血清诱导型一氧化氮合成酶(i NOS)浓度变化情况及其相关因素。方法将2012年9—12月中国医科大学呼吸疾病研究所研究纳入的受试者分为单纯OSAHS组、OSAHS合并高血压组及健康对照组,分别对三组受试者血清i NOS浓度进行定量检测,比较各组间血清iNOS浓度并进行相关分析。结果与健康对照组血清iNOS浓度相比[(3.04±0.38)nmol/L],单纯OSAHS组[(3.35±0.37)nmol/L]明显上升(P<0.05),OSAHS合并高血压组升高更为明显[(3.66±0.26)nmol/L,P<0.01)]。相关性分析提示,单纯OSAHS组患者iNOS浓度与呼吸暂停低通气指数、氧饱和度低于90%的时间占监测时间的百分比及最低指端血氧饱和度相关(r值分别为0.43、0.47和-0.43,均P<0.05),而OSAHS合并高血压组患者iNOS浓度与呼吸暂停低通气指数、氧饱和度低于90%的时间占监测时间的百分比及舒张压水平呈正相关(r值分别为0.46、0.46和0.45,均P<0.05)。结论 OSAHS患者血清iNOS浓度较正常组增加,且与疾病严重程度密切相关,当合并高血压时血清iNOS浓度上升更明显,提示OSAHS本身可独立导致iNOS的改变,而iNOS的升高在OSAHS致高血压中可能起一定作用。

Objective To compare the level of serum iNOS （induced nitric oxide synthase） in patient with simple obstructive sleep apnea hypopnea syndrome （OSAHS） with hypertention, and to explore its related factors. Methods The subjects were divided into simple OSAHS group, OSAHS compared with hypertension group and normal control group. Quantitatively detect the serum levels ofiNOS in the three groups of subjects respectivel）5 and iNOS serum levels between groups were compared and analyzed. Results Compared with normal control group[（3.04±0.38） nmol/L], iNOS level significantly increased in patients with simple OSA/-IS [（3.35±0.37） nmol/L, P〈0.05], and it increased more significantly in the group with hypertension [（3.66±0.26） nmol/L, P〈0.01]. Correlation analysis showed that iNOS levels in patients in OSAHS group were associated with AHI （apnea hypopnea index）, SIT9076 （the percentage of time that oxygen saturation below 90% accounted for monitoring time） and LspO2 （minimum fingertip oxygen saturation） （r=-0.43, 0.47, -0.43, P〈0.05）, while in the OSAHS with hypertension group, INOS levels were positively correlated with AHI, SIT90 and diastolic blood pressure levels （r=-0.46, 0.46, 0.45, P〈0.05）. Conclusion The serum levels in patients with OSAHS present an increase ofiNOS compared with those of normal group, and are closely related to the severity of the disease. It rises more significantly in patients with OSAHS with hypertension, which suggests that OSAHS can lead to changes ofiNOS level independentl）5 and INOS increase might play a role in hypertension.