重度阻塞性睡眠呼吸暂停低通气综合征合并高血压患者左心及血清心肌酶的变化

Changes in left cardiac structure and serum myocardial enzymes of the patients with severe obstructive sleep apnea hypopnea syndrome complicated with hypertension

目的观察重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并高血压患者左心结构和功能异常情况以及血清心肌酶的变化。方法 103例经多导睡眠监测确诊为重度OSAHS患者,按有无合并高血压分为单纯OSAHS组(55例)和高血压合并OSAHS组(48例)。同时选取20例原发性高血压患者(单纯高血压组)和20例健康查体人员作为对照(对照组)。观察并对比4组的血清肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)及乳酸脱氢酶(LDH)水平;两组OSAHS患者的心脏结构和功能异常率。结果高血压合并OSAHS组的CK水平最高(P<0.05或0.01),CK-MB、LDH水平均高于对照组(P<0.05或0.01),CK-MB水平高于单纯高血压组(P<0.05)。单纯OSAHS组的CK、LDH水平高于对照组(P<0.05或0.01)。单纯高血压组的LDH较对照组高(P<0.05)。高血压合并OSAHS组左心室向心性肥厚、左心房增大、主动脉瓣返流、舒张早期心室充盈速度最大值与舒张晚期心室充盈速度最大值比值(E/A)<1的发生率均高于单纯OSAHS组(均P<0.05);CK、LDH、左心室向心性肥厚与AHI呈正相关(P<0.05),与LSaO_2呈负相关(P<0.05);E/A与AHI呈负相关(P<0.05),与LSaO_2呈正相关(P<0.05)。结论部分重度OSAHS患者的心脏结构和功能存在异常,而合并有高血压者此概率更高。

Objective To observe the changes in left cardiac structural and functional abnormalities as well as serum myocardial enzymes of the patients with severe obstructive sleep apnea hypopnea syndrome （OSAHS） complicated with hypertension （HT）. Methods A total of 103 OSAHS cases diagnosed by polysomnography were divided into OSAHS Group （n=55） and OSAHS＋HT group （n=48）. Meanwhile, 20 patients with primary hypertension were selected as HT Group and 20 healthy persons were selected as Control Group. The CK, CK-MB, and LDH level of the four groups and abnormal cardiac structure and function in OSAHS Group and OSAHS＋HT Group were observed and compared. Results OSAHS＋HT Group had the highest CK level （P〈0.05 or 0.01）, a CK-MB and LDH level higher than Control Group （P〈0.05 or 0.01）, and a CK- MB level higher than HT Group （P〈0.05）. LDH level of HT Group was higher than that of Control Group （P〈0.05）. OSAHS＋HT Group was higher than OSAHS Group in terms of the incidence of left ventricular hypertrophy, left atrial enlargement, aortic valve regurgitation and E/A〈I （P〈0.05 for all）; CK level, LDH level and left ventricular hypertrophy were positively correlated with AHI level （P〈0.05）, and negatively correlated with LSaO2 （P〈0.05）; E/A was negatively correlated with AHI （P〈0.05） and positively correlated with LSaO2 （P〈0.05）. Conclusion Some patients with severe OSAHS have cardiac structural and functional abnormality while those complicated with hypertension have a higher incidence.