高血压合并阻塞性睡眠呼吸暂停低通气综合征患者NHDL-C/apoA-1水平变化研究

目的 探讨高血压合并OSAHS患者非高密度脂蛋白/载脂蛋白A1 (NHDL-C/apoA-1)比值与OSAHS严重程度的关系及经鼻持续气道正压通气(nCPAP)干预疗效研究.方法 原发性高血压(EH) +OSAHS者82例;单纯EH组79例.2组患者分别进行多导睡眠监测(PSG)、血脂水平、NHDL-C/apoA-1等检测,观察2组患者上述指标变化;依据睡眠呼吸暂停低通气指数(AHI)将EH+OSAHS组分为轻(28例)、中(29例)、重度(25例)组,NHDL-C/apoA-1与OSAHS严重程度(AHI)对比相关分析;以及47例中重度EH+ OSAHS患者nCPAP治疗前后NHDL-C/apoA-1变化.结果 ①与单纯EH组相比,EH+ OSAHS组中最低血氧饱和度(minimumSaO2)(71.7±5.4)％ vs (91.4±2.5)％]、高密度脂蛋白胆固醇(HDL-C)(0.8±0.2) mmol/L vs (1.1±0.1)mmol/L]减低,血氧饱和度低于90％的时间占睡眠时间百分比(TST90％) (27.3±1.5)％vs (0±0)％]、AHI(45.4±8.6)次/h vs(2.0±0.3)次/h]、总胆固醇(TC)(4.2±0.5) mmol/L vs (3.7±0.4)mmol/L]、甘油三酯(TG)(2.5±0.8) mmol/L vs(2.0±0.4)mmol/L]、NHDL-C (2.6±0.7) mmol/L vs (2.1±0.5)mmol/L]、NHDL-C/apoA-1 (3.2±1.2) vs (2.8±0.9)增高,差异有统计学意义(P＜0.05).②NHDL-C/apoA-1在OSAHS患者轻、中、重度3组中随着AHI指数增加,差异有统计学意义(P＜0.05).③EH+OSAH患者AHI与NHDL-C/apoA-1呈正相关(r=0.649,P=0.005).④中重度EH+ OSAHS患者nCPAP治疗前后NHDL-C/apoA-1 (2.8±1.1) vs (3.7±1.4)明显下降,差异有统计学意义(t =3.5,P＜0.05).结论 NHDLC/apoA-1与OSAHS 严重程度相关,nCPAP治疗前后NHDL-C/apoA-1明显改善,可能为EH合并OSAHS患者临床治疗的靶标评价和治疗靶点.

Effect of continuous positive airway pressure therapy on ratio of non-high-density lipoprotein to apolipoproteinA-1 in patients with hypertension and obstructive sleep apnea hypopnea syndrome

Objective The aim of our study was to explore the relationship between ratio of non-high density lipoprotein cholesterol (NHDL-C) to apolipoproteinA-1 (apoA-1) and severity of obstructive sleep apnea hypopnea syndrome (OSAHS) and to determine the effect of nasal continuous positive airway pressure therapy (nCPAP) in patients with hypertension and OSAHS.Methods One hundred and fifty-seven hypertensive patients with OSAHS (EH + OSAHS group,n =82) and without OSAHS (EH group,n =79) were evaluated for polysomnogram and serum lipid profiles before and after intervention of nCPAP.Patients with hypertension and OSAHS were grouped according the apnea hypopnea index (AHI) as mild (n =28),moderate (n =29) and severe (n =25).Pearson and Spearman correlation analysis was performed.Results Hypertensive patients with OSAHS,compared with hypertensive patients,had significant lower minimum SaO2 (71.7± 5.4) vs (91.4±2.5) ％] and HDL-C(0.8 ±0.2) mmol/L vs (1.1 ±0.1) mmol/L],and higher percentage of SaO2 less than 90％ (27.3± 1.5)％ vs (0±0) ％],AHI (45.4±8.6) times/h vs (2.0±0.3) times/h,total cholesterol (4.2±0.5)vs (3.7±0.4) mmol/L],triglyceride(2.5±0.8) mmol/L vs (2.0±0.4) mmol/L],NHDL-C (2.6±0.7) mmol/L vs (2.1±0.5) mmol/L] and ratio of NHDL-C of apoA-1 (3.2±1.2) vs (2.8±0.9).Ratio of NHDL-C to apoA1 was significantly increased from the mild to severe of OSAHS.Ratio of NHDL-C to apoA1 was also positively with AHI in patients with hypertension and OSAHS (pearson correlation coefficient was 0.649,P =0.005).After nCPAP treatment,ratio of NHDL-C to apoA1 was significantly reduced in moderate-sever OSAHS patients (2.8 ± 1.1) vs (3.7 ± 1.4) (t =3.5,P ＜ 0.05).Conclusions In conclusion,ratio of NHDL-C to apoA1 was significantly associated with severity of OSAHS.In addition,6 months of nCPAP in patients with hypertension and OSAHS significantly decreased ratio of NHDLC to apoA1.