高血压共病性失眠患者血浆皮质醇测定及临床意义

Clinical Significance of Plasma Cortisol Testing for the Combined Hypertension and Insomnia Patients

目的检测高血压共病性失眠症患者血浆皮质醇水平,评估其临床意义及对失眠症过度觉醒的预测价值,探讨两者可能的病理生理机制。方法纳入高血压共病性失眠症患者25例(高血压共病性失眠组)、原发性失眠症患者25例(原发性失眠组)和对照组25例(正常睡眠),分别检测清晨血浆皮质醇水平,比较3组匹兹堡睡眠质量指数(PSQI)、过度觉醒量表(HAS)评分,分析各量表评分与皮质醇水平的相关性。结果高血压共病性失眠组患者的PSQI、HAS评分、血浆皮质醇水平均较原发性失眠组和对照组增高,且血浆皮质醇水平与两个量表总分及各因子分呈正相关。结论过度觉醒机制可能是失眠症发生的重要机制,血浆皮质醇水平可视为代表觉醒水平的重要指标,高血压病和失眠可能通过共同的下丘脑-垂体-肾上腺轴的病理生理机制相互作用,相互影响。

Aim To observe plasma cortisol levels of the comorbid hypertension and insomnia patients to explore the clinical significance of detection and confirm the hyperarousal theory and common pathophysiological mechanisms. Methods Twenty-five combined hypertension and insomnia patients and 25 primary insomnia patients were included, while another 25 normal sleepers as the control group. Plasma cortisol levels in the morning were detected and compared with the Pittsburgh Sleep Quality Index（PSQI） and the Hyper Arousal Scale（HAS） and their correlation with the cortisol levels. Results The PSQI and HAS scores and plasma cortisol levels were significantly higher in the combined hypertension and insomnia group compared primary insomnia group and normal control group（P〈0.05）. At the same time plasma cortisol levels and two scale scores and each factor were positively correlated（P〈0.05）.Conclusion Hyper arousal theory may be an important mechanism for insomnia. Plasma cortisol can be seen as an important index of arousal level. Hypertension and insomnia may interact with each other through the pathophysiological mechanisms of the common hypothalamus-pituitary-adrenalaxis.