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上海市卫生健康委员会
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高血压合并阻塞性睡眠呼吸暂停低通气综合征患者发生颈动脉硬化的危险因素
Analysis of hypertension patients with obstructive sleep apnea-hypopnea syndrome carrying danger of risk factors in carotid artery atherosclerosis

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DOI:
作者:
赵普庆
ZHAO Pu-qing
作者单位:
上海市中西医结合医院
Shang Hai Traditional Chinese Medicine Integrated Hospital
关键词:
高血压；阻塞性睡眠呼吸暂停低通气综合征；颈动脉硬化；危险因素
Hypertension；Obstructive sleep apnea-hypopnea syndrome；Carotid artery atherosclerosis；Risk factors
摘要:
【摘要】目的 探讨高血压合并阻塞性睡眠呼吸暂停综合征患者影响颈动脉内膜中层厚度（IMT）的危险因素。方法 采用回顾性研究方法，将诊断明确的高血压患者93例，根据多导睡眠仪监测的结果，将高血压合并阻塞性睡眠呼吸暂停综合征患者42例作为睡眠呼吸暂停组，单纯高血压患者51例作为高血压组，所入选的患者均行血生化和颈动脉多普勒超声检查。结果 （1）睡眠呼吸暂停组的体质量、体质量指数（BMI）、颈围、腰围、臀围、腰臀比、收缩压、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、空腹血糖（FPG）、2小时血糖（2hPG）、血肾素（Renin）、血管紧张素Ⅱ（AngⅡ）、颈总动脉IMT均高于高血压组（P＜0.05～0.01）；（2）睡眠呼吸暂停组的呼吸暂停或低通气次数、呼吸暂停或低通气累计时间、AHI、平均血氧饱和度、夜间平均血氧饱和度、血氧饱和度低于百分之90时间、血氧饱和度低于百分之90的缺氧事件总数、睡眠期间血氧饱和度低于百分之90的时间占睡眠时间百分比均高于高血压组（P＜0.01）；（3）Pearson相关分析显示，颈总动脉IMT与TC、2hPG、收缩压、LDL-C、FPG、呼吸暂停或低通气次数、呼吸暂停或低通气累计时间、AHI、血氧饱和度低于百分之90时间、血氧饱和度低于百分之90的缺氧事件总数呈正相关（r＝0.36，0.019，0.011，0.015，0.047，0.002，0.003，0.004，0.028，0.023，P＜0.05～0.01）；（4）以颈总动脉IMT为因变量行多元线性逐步回归分析，结果显示，AHI、呼吸暂停或低通气次数、收缩压、LDL是颈总动脉IMT 的独立影响因素。结论 高血压合并阻塞性睡眠呼吸暂停综合征患者在缺氧、高血压和血脂异常这三方面参与并加速颈动脉硬化进程；此外，AHI、呼吸暂停或低通气次数、LDL、收缩压是颈总动脉IMT的独立影响因素。
【Abstract】 Objective To investigate the risk factors which affected the intima-media thickness(IMT) of carotid artery atherosclerosis in hypertension patients with obstructive sleep apnea-hypopnea syndrome(OSAHS). Methods Retrospective study was performed. According to the results of polysomnograph(PSG), ninety-three hypertension patients were divided in two groups:hypertension patients with OSAHS as OSAHS group(n=41) and hypertension patients group as hypertension group(n=51). All enrolled were tested blood biochemical examination and detected IMT by ultrasonograph. Results (1) Weight,body mass index(BMI),neck circumference, waist circumference, hip circumference, waist-hip ratio, systolic blood pressure, total cholesterol(TC), triglyceride(TG), low density lipoprotein cholesterol(LDL-C), fasting plasma glucose(FPG), 2 hour plasma glucose(2hPG), rennin, angiotensinⅡ(AngⅡ) and the intima-media thickness(IMT) of carotid artery atherosclerosis, were significantly increased in OSAHS group(P＜0.05～0.01). (2) Apnea-hypopnea index(AHI), its events and total events duration, mean and nocturnal mean oxygen saturation, oxygen saturation lower than 90% events and total events duration, together with percentage of time of oxygen saturation lower than 90%, were higher in OSAHS group(P＜0.01). (3)Pearson correlation analysis showed that IMT of carotid artery atherosclerosis was positively and significantly correlated with TC, 2hPG,systolic blood pressure,LDL-C,FPG,AHI and its events and total events duration, oxygen saturation lower than 90% events and total events duration.(r＝0.36,0.019, 0.011,0.015,0.047,0.002,0.003,0.004,0.028,0.023,P＜0.05～0.01). (4) Multiple linear stepwise regression analysis showed that AHI and its events,LDL,systolic blood pressure are independent factors of IMT of carotid artery atherosclerosis. Conclusion Hypertension patients with OSAHS engageded and accelerated in the process of carotid artery atherosclerosis in hypoxia, hypertension and dyslipidemia. In addition,AHI and its events,LDL,systolic blood pressure are independent factors to affect IMT of carotid artery atherosclerosis.

 

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