悬雍垂组织病理学改变与阻塞性睡眠呼吸暂停低通气综合征关系的研究

目的：通过对OSAHS患者和无OSAHS病史男尸的悬雍垂病理组织学的研究,探讨悬雍垂组织的病理学变化与OSAHS的关系。方法：采用34例因OSAHS而进行部分保留悬雍垂的腭咽成形术切除的悬雍垂作为实验组,其中24例为重度阻塞,中度阻塞10例;取无OSAHS病史的男性尸检悬雍垂10为对照组。光镜下观察其组织结构的改变,主要对肌肉纤维的形态、密度以及排列状态进行观察,并对肌间的组织以及上皮组织结构进行观察,用半定量分析法对结果进行分析。结果：与对照组相比较,OSAHS组悬雍垂粘膜上皮层结构尚完整,但伴有明显的炎症表现,固有层厚度为0.92±0.21mm,对照组为0.24±0.07mm,P〈0.01;同时,不同程度OSAHS、不同程度体块指数患者的粘膜固有层厚度的比较均有显著性差异。OSAHS组的悬雍垂肌纤维密度为85.47±29.54,对照组为149.70±22.68,P〈0.01;重度OSAHS悬雍垂肌纤维密度为72.04±14.47,中度重度OSAHS为117.70±32.09,P〈0.01。对照组中肌纤维的排列整齐、连接紧密、形态规整,实验组绝大部分悬雍垂肌纤维标本排列不规则,而且随着的OSAHS程度的加重,其排列越混乱。结论：OSAHS患者的悬雍垂从粘膜到肌肉都发生明显的病理改变,出现粘膜固有层增厚,肌纤维密度减少和肌纤维排列混乱、变性等表现,并且随着OSAHS程度的加重而加剧。提示悬雍垂组织的病理改变与OSAHS发生、发展有密切的相关性。

THE INVESTIGATION OF THE RELATIONSHIP BETWEEN HISTOLOGICALAND STRUCTURAL CHANGES IN THE UVULA ANDOBSTRUCTIVE SLEEP APNEA-HYPOPNEA SYNDROME

Objective：This study was conducted to investigate histopathol ogical changes in uvula tissues in patients with obstructive sleep apnea-hypopnea syndrome（OSAHS）and correlation of BMI.Methods：Uvulas were obtained by uvulopalatopharyngoplasty in 24 patients with moderate OSA HS and 10 patients with severe OSAHS and by autopsy in 10 individuals not known to have OSAHS.Light microscopy（×100） were applied to observe the histology structure,incluing the shape,density and arrangement of muscle and spatium intermusculare and epithelial tissue.Half-quantity-analytical method was applied to investigate the changes.Results：The thickness of the lamina propria（an index of interstitial edema） was also significantly increased in patients with OSAHS compared with controls（0.92±0.21mm vs.0.24±0.07 mm,respectively;P〈0.01） accompanying plasma cell infiltration and interstitial edema.Average quanity of muscle in cross section of uvalawere significant difference between OSAHS and controls（85.47±29.54 vs 149.70±22.68,respectively;P〈0.01）and between moderate OSAHS and severe OSAHS（117.70±32.09 vs 72.04±14.47,respectively;P〈0.01） But there is no statistically significant difference among OSHAS with different BMI.The anomalistic arrangement of muscle in OSAHS group were worsen graduately with the severity of OSAHS compared with regular muscle form control group.Conclusion：The authors conclude that thickening and inflammation of lamina propria,numerical decreasing and morphological changing of muscle,manifested in the uvula tissue of patients with moderate and severe,contribute to descending muscle tension and ascending compliance of pharyngeal wall,leading to upper airway occlusion observed during sleep in these patients.