高血压合并阻塞性睡眠呼吸暂停综合征患者的血压昼夜节律与新喋呤及高敏C反应蛋白的相关性

目的探讨高血压合并阻塞性睡眠呼吸暂停综合征(OSAS)患者的血压昼夜节律与新喋呤及高敏C反应蛋白(hsCRP)的关系。方法分析2005-01-2010-04在北京军区总院263临床部心内科连续入院的高血压患者367例,行睡眠监测后分为3组,单纯高血压组(A组,n=212),高血压合并轻度OSAS组(B组,n=107),高血压合并中重度OSAS组48例(C组,n=48)。睡眠监测当日或次日早晨检测血浆新喋呤及hsCRP,并行24h动态血压监测。结果与A组相比,B、C组的新喋呤浓度(28.85±6.24)、(38.44±7.45)比(11.68±5.87)nmol/L],hsCRP(6.54±0.98)、(9.68±1.75)比(3.36±1.72)mg/L]升高(均P<0.05)。A组昼夜血压曲线呈非杓型占44.5%,B、C组分别占67.7%和84.2%,3组间比较,差异有统计学意义(P<0.05)。相关分析表明血压昼夜下降比与新喋呤及hsCRP浓度呈负相关。多元逐步回归分析显示:呼吸暂停低通气指数(AHI)、收缩压夜间下降率、平均氧饱和度及最低氧饱和度是影响新喋呤的主要因素;AHI、平均氧饱和度是影响hsCRP的主要因素。结论高血压合并OSAS患者血浆新喋呤等炎性因子增高,并与OSAS严重程度呈正相关。

Relationship between circadian rhythm of blood pressure and plasma neopterin and high sensitivity C-reactive protein in hypertensive patients with obstructive sleep apnea syndrome

Objective To reveal the relationship between the plasma neopterin(Npt) and high sensitivity C-reactive protein(hsCRP) and circadian rhythm of blood pressure in hypertensive patients with obstructive sleep apnea syndrome(OSAS).Methods A total of 367 hypertensive patients,who hospitalized continuously in the unit of cardiology of No.263 clinical department of Beijing PLA general hospital from January 2005 to April 2010 were involved in this study.They were divided into three subgroups according to polysomnography(PSG):hypertensive alone(A group,n=212),hypertensive with mild OSAS(B group,n=107) and hypertensive with moderate-severe OSAS(C group,n=48).The determination of plasma Npt and hsCRP concentration were measured on or after the day of PSG,and ambulatory blood pressure(ABPM) were monitored at the same time in the first week of admission.Results Compared to group A,plasma Npt in group B and C were higher \(28.85±6.24),(38.44±7.45) vs(11.68±5.87)nmol/L,P<0.05\],as well as plasma hsCRP \(6.54±0.98),(9.68±1.75) vs(3.36±1.72)mg/L,P<0.05\].Non-dipper curve in group A was 44.5%,while in group B and C were 67.7% and 84.2%,respectively(all P<0.05).Correlation analysis indicated that D-value of nocturnal and diurnal blood pressure were correlated with plasma neopterin and hsCRP negatively.Multiple stepwise regression analysis showed that AHI,drop rate of systolic blood pressure,mean oxygen sat main impact factors of neopterin;while AHI,MSaO2 were the mian impact factors of hsCRP.Conclusion Plasma neopterin and hsCRP were higher in hypertensive patients with OSAS than pure hypertension,which correlated with the severity level of OSAS positively.