阻塞性睡眠呼吸暂停低通气综合征患者炎症因子与高血压的相关性

目的：探讨阻塞性睡眠呼吸暂停综合征（0SAHS）患者炎症因子的水平与合并高血压的相关性。方法：根据24h动态血压和多导睡眠图（PSG）监测结果将84例受检者分为正常对照组（n=22）、单纯高血压组（HT组，n=31）和中重度OSAHS合并高血压组（OSAHS＋HT组，n=31）。OSAHS诊断根据PSG监测结果，血压监测采用24h动态血压监测仪．以酶联免疫吸附法测定白细胞介素18（IL—18）、超敏C反应蛋白（hs—CRP）、肿瘤坏死因子α（TNF-α）及血管细胞黏附分子1（VCAM-1）的浓度。结果：①OSAHS＋HT组巾非杓型血压的发生率为62％，明显高于HT组的31％（P〈0．05）。②OSAHS＋HT组24h、白天、夜间平均脉压[分别为（50．5±11．8）mmHg（1mmHg=0．133kPa）、（51．4±10．9）mmHg、（52．2±15．8）mmHg]明显高于HT组[分别为（45．9±6．9）mmHg、（48．1±8．1）mmHg、（43．9±6．7）mmH朗（均P〈0．05）。③OSAHS＋HT组的IL-18、hs—CRP、TNF—α、VCAM—1浓度明显高于HT组和正常对照组；HT组的IL-18、hs-CRP、TNF—d、VCAM-1浓度明显高于正常对照组（均P〈0．05）。④OSAHS＋HT组的hs—CRP和VCAM-1浓度变化与呼吸紊乱指数、氧减饱和度呈正相关（P〈0．01）。结论：中重度OSAHS患者存在明显炎症反应，可能与其血压昼夜节律及脉压的变化相关。

Correlation between inflammatory factors and hypertension in patients with obstructive sleep apnea hypopnea syndrome

Objective To investigate the correlation between inflammatory factors and hypertension in patients with moderate/severe obstructive sleep apnea hypopnea syndrome （OSAHS）. Methods Eighty-four persons were divided into healthy group （n=22）, hypertension group （HT group, n=31）, and moderate/severe OSAHS with hypertension group （OSAHS＋HT group, n=31） according to the results of examination of polysomnography and blood pressure （BP） measured by 24 h ambulatory blood pressure monitoring （ABPM）. Serum levels of interleukin （IL）-18 ,high sensitivity C-reactive protein（hs-CRP）,tumor necrosis faetor（TNF）-α,vaseular cell adhesion molecule 1 （VCAM -1） were measured by enzyme linked immunosorbent assay （ELISA）. Results （1）The rate of non-dipper profile of blood pressure in OSAHS＋HT group （60%） was significantly higher than that in HT group （31%）. （2） Twenty-four hours, daytime, nighttime mean pulse pressure in OSAHS ＋HT group[（50.5±1 1.8） mm Hg （1 mm Hg = 0.133 kPa）, （51.4±10.9） mm Hg, （52.2±15.8） mm Hg, respectively] was significantly higher than that in hypertension group [（45.9±6.9） mm Hg, （48.1±8.1） mm Hg, （43.9±6.7） mm Hg, respeetively]（all P〈0.05）. （2） Serum levels of IL-18, hs-CRP, TNF-α, and VCAM -1 were significantly higher in OSAHS＋ HT group than that in both the hypertension group and healthy group （all P〈0.05）, and also statistically higher in hypertension group than in healthy group. （4） In OSAHS ＋ HT group, serum levels of hs-CRP and VCAM-1 were positively correlated with apnea-hypopnea index （AHI）and O2 desaturation （all P〈0.01）. Conclusions Remarkable inflammatory reaction existed in patients with moderate /severe OSAHS and might be correlated with the changes of the circadian rhythm of blood pressure variability and pulse pressure.