合并OSAS的难治性高血压患者醛固酮水平的研究

目的观察难治性高血压（RH）患者中阻塞性睡眠呼吸暂停综合征（OSAS）的患病率,及RH患者的血压和血浆醛固酮（ALD）、血浆肾素活性（PRA）的水平,OSAS对RH患者的影响及可能的机制。方法选择100例RH患者,均行多导睡眠监测,根据结果分为合并OSAS的RH组,和单纯RH组作为对照,分别测睡前（10：00PM）、夜间（02：00AM）和清晨（6：00AM）的血压及晨起（6：00AM）卧位血浆ALD、血浆PRA水平,ALD、PRA检测采用放射免疫分析法。结果抵抗型高血压患者中85％存在OSAS。与RH患者相比合并OSAS的RH患者血浆醛固酮增高（11．0ng／dl对5．5．g／dl,P〈0．05）,血浆肾素活性水平无差异[（0．20±0．12）μg/（L·h）对（0．27±0．14）μg/（L·h）,P〉0．05]。还观察到男性患者OSAS的患病率更高（89．O％对61．1％,P〈0．05）,OSAS的病情更重[中位呼吸暂停-低通气指数（AHI）分别为20．8次／h对10．8次／h,P〈0．01]且中位的ALD明显较高（12．0ng／dl对8．8ng／dl,P〈0．01）。结论RH患者中有较高的OSAS患病率,且合并OSAS的RH患者有较高的血浆醛固酮水平,可能是OSAS患者引起血压增高的机制。

Study of aldosterone level in refractory hypertension patients with OSAS

Objective To observe the prevalence rate of obstructive sleep apnea syndrome （OSAS） in refractory hypertension （RH） patients and the level of plasma aldosterone （ALD） , plasma renin activity （PRA） on the effects of OSAS in RH patients and its mechanism. Metboils One hunth＇ed cases of patients with RH were examined with polysomnography monitor and the patients were divided into RH combined with OSAS group and RH group based on the examination. Blood pressure （6AM） , ALD and PRA level were measured before going to bed （10PM）, at night （2 AM） and early morning. Results 85% of the patients with resistant hypertension had OSAS. Compared with RH patients, RH patients with OSAS showed increased ALD （ 11.0 ng/dl vs 5.5 ng/dl, P 〈 0.05 ）. However, no difference was found in the level of PRA （0.20±0.12 μg/L·h vs 0.27 ±0.14 μg/L· h, P 〉0.05）. In addition, higher prevalence rate of OSAS, and higher apnea - hypopnea index median and ALD median were found in male patients than those in female patients （89.0% vs 61.1% , P 〈0.05 ; 20.8/h vs 10.8/h, P 〈0.01 and 12. 0 ng/dl vs 8.8 ng/dl, P 〈 0.01 respectively）. Conclusion Refractory hypertension patients have higher prevalence of OSAS, and patients with refractory hypertension and combined with OSAS have higher plasma aldosterone levels, indicating high level of plasma aldosterone may be the mechanism of high blood pressure.