难治性高血压合并睡眠呼吸暂停综合征患者血液细胞参数变化

Changes of blood cell parameters in patients with refractory hypertension complicated with sleep apnea syndrome

目的观察睡眠呼吸暂停综合征(sleep apnea syndrome,SAS)合并难治性高血压(resistant hypertension,RH)患者的外周血细胞参数变化,分析固有免疫细胞参与SAS促RH发生、发展的机制。方法选择2018年1月至2019年12月广东省第二人民医院收治的90例SAS患者,依据是否合并RH分为SAS合并RH组和SAS组。依据最低血氧饱和度将患者分为正常组、轻度缺氧组、中度缺氧组、重度缺氧组。记录患者睡眠监测参数、血细胞参数、C反应蛋白、超声心动图。结果SAS合并RH组的重度缺氧患者比例显著高于SAS组,中度缺氧患者比例显著低于SAS组,差异有统计学意义(P<0.001)。SAS合并RH组患者的白细胞、中性粒细胞、淋巴细胞、中性粒细胞与淋巴细胞比值、血小板、C反应蛋白、左心室后壁厚度、室间隔厚度明显高于SAS组,差异有统计学意义(P<0.05)。不同缺氧程度分组患者间白细胞、中性粒细胞、淋巴细胞、血红蛋白、C反应蛋白、左心室后壁、室间隔厚度比较,差异有统计学意义(P<0.05)。结论SAS合并RH的患者随缺氧严重程度加剧,外周血固有免疫细胞增多、活化,提示缺氧引起的固有免疫细胞活化在SAS促RH形成中扮演重要角色。

Objectives To observe the changes of blood cell parameters in patients diagnosed with sleep apnea syndrome(SAS)and refractory hypertension(RH),and to analyze the potential role of innate immune system in promoting the occurrence and development of RH.Methods Totally 90 cases of SAS patients in Guangdong Second Provincial General Hospital were divided into SAS with RH group and SAS group according to the combination of RH or not.According to the minimum oxygen saturation,patients were divided into normal group,mild hypoxia group,moder⁃ate hypoxia group and severe hypoxia group.Sleep monitoring parameters,blood cell parameters,C-reactive protein,cardiac color doppler ultrasound parameters were recorded.Results The proportion of patients with severe hypoxia in SAS with RH group was significantly higher than that in SAS group,while the proportion of patients with moderate hypoxia was significantly lower than that in SAS group(P<0.001).The level of white blood cells,neutrophils,lympho⁃cytes,neutrophils to lymphocytes ratio,platelets,C-reactive protein,the thickness of left ventricular posterior wall and ventricular septum of SAS with RH group were significantly higher than those of SAS group(P<0.05).There were statistically significant differences in the level of white blood cells,neutrophils,lymphocytes,hemoglobin,C-reactive protein,thickness of left ventricular posterior wall and ventricular septum between groups of different severity degrees of hypoxia(P<0.05).Conclusions The proliferation and activation of innate immune system in SAS patients with RH increases with the severity of hypoxia,suggesting that the activation of innate immune cells caused by hypoxia plays an important role in the formation of RH promoted by SAS.