阻塞性睡眠呼吸暂停低通气综合征患者血浆ET-1水平及血压的临床研究

Observation on the Level of Plasma ET-1 and Blood Pressure in Patients with Obstructive Sleep Apnea-hypopnea Syndrome

目的 :探讨阻塞性睡眠呼吸暂停低通气综合征 (OSAHS)患者血浆内皮素 - 1(ET - 1)水平及血压的变化及意义。方法 :选择 2 5名中重度OSAHS患者及 2 5名正常人作对照。进行整夜睡眠多导生理记录仪 (PSG)监测 ,对确诊OSAHS者 ,第二夜施以nCPAP治疗 ,共 3d。分别于诊断和nCPAP治疗后晨起觉醒采血 ,正常对照也以相同方法采血 ,用放免法测定ET - 1并每日观察血压。结果 :①nCPAP治疗前 ,OSAHS患者平均动脉压 (MBP)、血浆ET - 1高于正常对照 (P <0 0 1) ;nCPAP治疗后 ,MBP、血浆ET- 1均降低 (P <0 0 1)。②ET - 1变化与MBP、睡眠呼吸暂停低通气指数 (AHI)、最低氧饱和度 (最低SaO2 )均明显相关。结论 :①睡眠窒息可引起血压升高及血浆ET- 1水平升高 ,经nCPAP治疗可以逆转。②ET -1的异常可能在OSAHS患者合并高血压中起一定的病理生理作用 。

Objective: To investigate the clinical implication of alterat ion of plasma endothelin levels 1(ET-1) and blood pressure in patients with o bstructive sleep apnea-hypopnea syndrome (OSAHS) Methods: Twent y -five patients with moderate and severe OSAHS and 25 normal controls were enrol led and monitored with PSG in the study Patients with OSAHS were treated with n CPAP for 3 days after being diagnosed ET-1 was measured on day of making diag n osis and on next three consecutive days mornings of nCPAP treatment by using rad io-immunoassay in patients as well as in normal controls At the same time the blood pressure w as observed six times a day Results: Before nCPAP, plasma levels of ET-1 and mean arterial pressure (MBP) were significantly higher in patients with OSAHS than those in controls (P<0 01); after nCPAP, plasma level of ET-1 a nd MBP were decreased significantly (P<0 01) Alteration in ET-1 levels wa s closely correlated with MBP、 AHI and oxygen saturation Conclusion: Sleep apnea can make the blood pressure and ET-1 level increased, and bloo d pressure and ET-1 level can be recovered with consecutive nCPAP treatment The alteration of ET-1 may have some pathophysiological roles in the genesis of hypertension and cardiovascular risk can be reduced in patients with OSAHS if the patients were given the nCPAP treatment earlier