肽类物质在阻塞性睡眠呼吸暂停综合征夜间血压变化中的作用

Relationship between Mood pressure and vasoactive substances in patients with obstructive nocturnal apnea syndrome

目的 通过对正常人、阻塞性睡眠呼吸暂停综合征(Obstructive sleep apnea syndrome,OSAS)及OSAS患者持续正压通气(Continuous positive airway pressure,CPAP)治疗前后血内皮素(Endothelin,ET)、血管紧张素Ⅱ(AngiotensionⅡ,AngⅡ)、心钠素(Atrial natriuretic peptide,ANP)和降钙素基因相关肽(Calcitonin generelated peptide,CGRP)对比研究,探讨它们与OSAS患者夜间平均血压(the mean artery pressure,MAP)之间的相互关系及CPAP治疗对其的影响和效果。方法 选取经多导睡眠图(PSG)检查确诊为重度OSAS患者15例,正常对照10例,给予CPAP治疗的OSAS患者12例,在测量MAP的同时,留取血浆标本,测定ET、AngⅡ、ANP和CGRP浓度,并与OSAS患者MAP进行相关性分析。结果 (1)OSAS患者较对照组AHI、MAP显著增高,平均和最低血氧饱和度(SaO_2)明显降低,血浆ET、AngⅡ和ANP浓度显著增高,CGBP浓度明显降低(P<0.05),且ET、Ang、ANP,与MAP呈正相关关系(r=0.643、0.527、0.612);(2)OSAS患者经CPAP治疗后,Ⅰ、Ⅱ期睡眠明显减少,REM睡眠明显增加,AHI、MAP均显著降低,平均和最低SaO_2显著增加,血浆中ET、AngⅡ、ANP浓度明显降低,CGRP浓度显著升高。结论 (1)OSAS患者夜间血压升高,无正常人夜间血压降低的节律;(2)OSAS患者引起的低氧?

Objective To study the relationship between blood pressure and vasoactive substances in patients with obstructive nocturnal apnea syndrome (ONAS) ,and the effects of continuous positive airway pressure (CPAP) on the disease. Methods Ten healthy control, 15 patients with severe ONAS confirmed by polysomnography,and 12 ONAS patients treated by CPAP were recruited. Mean arterial pressures (MAP) at night were measured, and plasma concentrations of endothelin (ET), angiotensin Ⅱ (Ang Ⅱ ),atrial natriuretic peptide (ANP) and calci-fonin gene-related peptide (CGRP) in all groups were assayed,and the correlation between the two characteristics was analyzed. Results (1)Compared with the controls, the indexes of apnea/hyponea (AHI) and MAP in the ONAS patients were markedly high, but the mean and the lowest Sa02 were notably low.The levels of plasma ET, Ang Ⅱ and ANP in these patients increased dramatically, while the level of plasma CGRP decreased significantly. Moreover,the ET,Ang Ⅱ and ANP levels were in positive corelation with MAP. (2)In ONAS patients,after receiving the CPAP treatment , the time of phase Ⅰ and Ⅱ sleep decreased, and the time of rapid eye movement increased. In addition, both AHI and MAP dropped, while the mean and the lowest SaO2 elevated. In contrast to CGRP,the other vasoactive substances decreased significantly. Conclusions (1)At night the blood pressure of the ONAS patients rises while that of normal people drops down. (2)Hypertension at night in ONAS is induced by increased secretion of ET, Ang II and ANP, and depletion or reduction of CGRP resulting from hypoxemia and hy-percapnia in ONAS. (3)The CPAP therapy not only improves the quantity of sleep, corrects hypoxemia in patients,but also decreases the blood pressure by lowering the levels of ET.Ang Ⅱ and ANP and increases that of CGRP.