高血压病合并阻塞性睡眠呼吸暂停综合征患者的血脂代谢特征

目的探讨高血压病合并阻塞性睡眠呼吸暂停综合征（OSAS）患者中血脂代谢的特点。方法选择896例住院的高血压患者，男655例，女241例。根据多导睡眠仪监测结果分为4组：单纯高血压组243例，高血压合并轻度OSAS组245例，高血压合并中度OSAS组195例，高血压合并重度OSAS组213例。所有患者均行多导睡眠监测，测量身高、体重、血压，并采集次日晨起外周血测定总胆固醇（Tc）、高密度脂蛋白胆固醇（HDL—C）、低密度脂蛋白胆固醇（LDL—C）、甘油三酯（TG）、空腹血糖（FPG）、尿酸（UA）、C反应蛋白（CRP）等水平。结果（1）四组中男性患者所占的比例均高于女性患者（P〈0．01）。高血压合并重度OSAS组的年龄（48．09±9．48）、体质指数（BMI）（29．46±3．83）、睡眠呼吸暂停紊乱指数（AHI）45．90（37．55，63．65）]、平均血氧饱和度（MSpO：）（89．084±4．93）、最低血氧饱和度（LSp02）（67．36±12．60）、TC（4．68±1．00）、TG2．03（1．54，2．88）]、UA（371．85±99．29）、hs．CRP1．43（0．82，3．056）]均高于单纯高血压组，差异有统计学意义（P〈0．05）；高血压合并重度OSAS组HDL—C（1．094±0．28）低于单纯高血压组，差异有统计学意义（P〈0．05）；（2）随OSAS严重程度增加2项及〉2项血脂代谢指标异常的患病率增高，差异有统计学意义（P〈0．01）；（3）高TG、高TC患病率在AHI≥15次／h组明显高于AHI〈15次／h组，差异有统计学意义（P〈0．05）；（4）在校正BMI、性别、年龄等常见危险因素后证明AHI依然与血脂代谢相关，是血脂代谢异常的独立危险因素。结论AHI是血脂代谢异常的独立危险因素，在高血压合并OSAS患者中随OSAS严重程度的增加TG、TC随之升高，同时血脂代谢异常的种类增加。

Characteristics of lipid metabolism in hypertensive patients with obstructive sleep apnea-hypopneasyndrome

Objective To explore the lipid metabolism in patients with hypertension and obstruc- tive sleep apnea-hypopnea syndrome. Methods A total of 896 patients （655 cases of male; 241 eases of female） was recruited who were hospitalized in our department, and were classified into four groups based on the finding of polysomnography （PSG） ： hypertensive without obstructive sleep apnea-hypopnea syndrome （OSAS） （ n = 243 ）, hypertensive with mild OSAS （ n = 245 ）, hypertensive with moderate OSAS （ n = 195）, and hypertensive with severe OSAS （ n = 213 ）. Multiple indices including apnea-hypopnea index （AHI）, lowest arterial oxygen saturation （lowest SaO2 ）, body mass index （BMI）, blood pressure, total cholesterol （ TC）, high density lipoprotein cholesterol （ HDL-C）, low density lipoprotein cholesterol （ LDL- C）, triglyeerides （TG）, fasting blood glucose （FBG）, uric acid （UA） , and high-sensitivity C-reactive protein（hs-CRP） were assessed, and the relevant risk factors of lipid metabolism were analyzed. Results （1）Male patients had more opportunities to suffer OSAS than female （ P 〈0. 01 ）. Compared with the groupwithout hypertensive, patients in severe OSAS group had higher levels of AGE （48. 09 ± 9. 48, BMI （29. 46 ±3.83）, AHI45.90（37.55,63.65） ], MSpO2 289. 08 ±4. 93）, LSpO2 （67. 36 ± 12. 60）, TC （4. 68 ± 1.00）, TGE2.03（1.54,2.88）], UA （371.85 ±99.29）, and hs-CRP1.43 （0.82,3.056） ] （ P 〈 0. 05） , and had lower levels of HDL- C（ 1. 09±0. 28 ）. （2） Two and more than two lipids abnormal meta- bolic indices increased prevalence with the increase of the severity of OSAS. （3）The prevalence of high TG, high TC in AHI I〉 15/ h was significantly higher than AHI 〈 15 group. （4） After adjustment for BMI, gen- der, age and other common risk factors, it confirmed that AHI was still related to lipid metabolism. AHI was an independent risk factor for abnormal lipid metabolism. Conclusions AHI was an independent risk factor for abnormal lipid metabolism. With increasing severity of OSAS, the levels TC, TG, and the catego- ry of abnormal lipid metabolism were also increased.