重叠综合征患者血管内皮功能的研究

目的探讨重叠综合征患者血管内皮功能的特点及其发生机制。方法测定36例重叠综合征、30例COPD患者外周血ET-1、NO水平,计算NO/ET-1比值,进行24h血压监测和PSG监测,记录24h MSBP、24h MDBP、24h MHR、dMSBP、dMDBP、dMHR、nMSBP、nMDBP、nMHR及AHI、Lapnea、LSaO2、SaO2<90%时间。结果重叠综合征患者血浆ET-1水平明显高于单纯COPD患者,NO水平及NO/ET-1较单纯COPD明显下降;24h动态血压整体水平、白昼水平、夜间水平及AHI、Lapnea、SaO2<90%时间较单纯COPD患者明显增加;血压昼夜节律消失;LSaO2较单纯COPD患者明显下降;重叠综合征患者ET-1与24h MSBP、24h MDBP、dMSBP、dMDBP、nMSBP、nMDBP、AHI、SaO2<90%时间呈正相关,与LSaO2呈负相关;NO水平与24hMSBP、24h MDBP、dMSBP、dMDBP、nMSBP、nMDBP、AHI、SaO2<90%时间呈负相关,与LSaO2呈正相关。结论重叠综合征存在严重的血管内皮功能失调,其发生可能与夜间低氧有关,其后果将导致重叠综合征患者血压上升,血压昼夜节律消失。

The study of vascular endothelial function in patients with overlap syndrome

Objective To explore the characteristics and pathogenesis of vascular endothelial function in patients with overlap syndrome.Methods 36 cases of overlap syndrome and 30 cases of COPD were selected.Plasma endothelin-1(ET-1)and nitric oxide(NO),polysomnography and ambulatory blood pressure,including 24 hours mean systolic blood pressure(24 hMSBP),24 hours mean diastolic blood pressure(24 hMDBP),24 hours mean heart rate(24 hMHR),day mean systolic blood pressure(dMSBP),day mean diastolic blood pressure(dMDBP),day mean heart rate(dMHR),night mean systolic blood pressure(nMSBP),night mean diastolic blood pressure(nMDBP),night mean heart rate(nMHR),apnea hypopnea index(AHI),the longest time of apnea(L apnea),the lowest oxygen saturation(L SaO2)and the accumulated time when SaO2 was lower than 90%(SaO2<90%)were examined.Results Compared with the parameters of COPD,there were significant increase in plasma ET-1,24 hMSBP,24 hMDBP,24 hMHR,dMSBP,dMDBP,dMHR,nMSBP,nMDBP,nMHR,AHL,L apnea and the accumulated time of SaO2<90% and decrease in plasma NO and NO/ET-1 of patients with overlap syndrome.The plasma concentration of ET-1 was positively correlated with 24 hMSBP,24 hMDBP,dMSBP,dMDBP,nMSBP,nMDBP,AHI and the accumulated time of SaO2<90%,and inversely correlated with L SaO2 in overlap syndrome.The plasma concentration of NO was inversely correlated with 24 hMSBP,24 hMDBP,dMSBP,dMDBP,nMSBP,nMDBP,AHI and the accumulated time of SaO2<90%,and positively correlated with L SaO2 in overlap syndrome.Conclusion sever disorder of vascular endothelial function was found in patients with overlap syndrome,the disorder was related with night hypoxemia and it resulted in the increased blood pressure and the disorder of day-night rhythm in blood pressure.