难治性高血压病合并阻塞性睡眠呼吸暂停低通气综合征患者危险因素分析

目的 研究住院患者难治性高血压病(RH)合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的独立危险因素.方法 选择我院RH患者100例,按多导睡眠监测结果分为:RH+ OSAHS组(n=54),RH组(n=46),收集患者的性别、身高、体重、BMI、吸烟史、服用降压药种类、高血压病程、血脂、血糖、血清尿酸、估算的肾小球滤过率(eGFR)、晨起卧位肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)、醛固酮和24h动态BP监测相关数据:24h平均SBP(24 h SBP)、24h平均DBP(24 h DBP)、24 h平均动脉压(24 h MAP).通过单因素和多因素Logistic回归分析RH合并OSAHS的独立危险因素.结果 ①RH+ OSAHS组患者24h DBP、24hMAP、LDL-C、血清尿酸、PRA、服用降压药种类均高于RH组[(86±10)mm Hg(1 mm Hg=0.133 kPa)比(81±10)mm Hg,(101 ±9)mm Hg比(97±8)mm Hg,(3.0±0.6)mmol/L比(2.7±0.5)mmol/L,(437 ±81).μmol/L比(385 ±72) μmol/L,1.44(0.56,3.09)ng/(ml·h)比0.78(0.19,1.96)ng/(ml·h),(4.0±0.7)种比(3.6±0.5)种,P＜0.05]；而年龄、病程低于RH组,差异有统计学意义[(48±12)岁比(54±12)岁,9(3,16)年比10(6,20)年,P＜0.05].②年龄(P=0.031,OR =0.964,95％ CI:0.932 -0.997)、高血压病程(P =0.015,OR=0.943,95％ CI:0.90 ～0.989)、24 h DBP(P=0.016,OR=1.054,95％ CI:1.010 ～1.101)、24 h MAP(P=0.014,OR=1.065,95％CI:1.013～1.121)、血清尿酸(P=0.002,OR=1.009,95％CI:1.003～1.014)、LDL-C(P =0.035,OR=2.193,95％ CI:1.003 ～1.014)与OSAHS独立相关；24 h MAP(P=0.02,0R=1.065,95％ CI:1.008～1.124),UA(P =0.002,OR=1.009,95％ CI:1.003 ～ 1.015),LDL-C(P=0.117,OR=1.877,95％ CI:0.854～4.128)为RH合并OSAHS的独立危险因素.结论 在RH患者中合并代谢异常是OSAHS的重要预测因子.

Risk factors in patients with resistance hypertension and obstructive sleep apnea hypopnea syndrome

Objective To evaluate the independent risk factor in patients with Resistance Hypertension （RH） and obstructive sleep apnea hypopnea syndrome （OSAHS）. Methods One-hundred patients were recruited, including 46 with resistance hypertension （ RH group, n = 46） and 54 patients of RH coexisted with OSAHS. The demographic and clinical data of patients were collected, including sex, height ,weight , body mass index（ BMI）, smoking,classes of taking antihypertension medications, duration of hypertension,serum lipid level,fasting blood glucose, serum uric acid （ UA）, estimated glomerular filtration rate （ eGFR ）, plasma renin activity （ PRA）, angiotension Ⅱ （Ang Ⅱ ）, aldosterone and taking Ambulatory blood pressure monitoring （ABPM）. The univariate and multivariate logistic regression were performed to estimate the risk factors of OSAHS in resistance hypertensions. Results （1） Compared with RH, RH ＋ OSAHS subjects 24 h DBP, 24 h mean artery pressure（ MAP）, LDL-C、UA,PRA, taking the classes of antihypertensive drugs were higher （P 〈0.05）, [ （86 ± 10）mm Hg vs （81 ± 10）mm Hg, （ 101± 9）mm ngvs （97±8）mm Hg,（3.0 ±0. 6） mmol/L vs （2.7 ±0, 5） mmol/L, （437± 81） μmol/L vs （385 ±72） μmol/L, 1.44 （0. 56,3.09） ng/（ ml ＊ h） vs 0. 78 （0. 19,1.96 ） ng/（ ml ＊ h）, （4. 0 ± 0. 7 ） classes vs （ 3. 6 ± 0. 5 ） classes,P 〈0. 051 ;RH ＋ OSAHS subjects were younger （48.13 ± 12. 29 vs 53.63 ± 12. 24）years, short course （9 （3,16） vs 10 （6,20））years （P 〈0.05）. （2） The univariate regression showed that age（P =0. 031 ,OR =0. 964, 95 % CI：O. 932-0. 997）, duration of hypertension （P = 0. 015, OR = 0. 943,95% CI： 0. 90-0. 989）, 24 h DBP （ P = 0. 016, OR = 1. 054,95% CI： 1. 010-1. 101 ）, 24 h MAP （ P = 0. 014, OR = 1. 065,95% CI： 1. 013-1. 121 ）, UA （ P = 0. 002, OR = 1. 009,95% CI： 1. 003-1. 014 ） , LDL-C （ P = 0. 035, OR = 2. 193,95% CI： 1. 003-1. 014 ） were the risk factores of OSAHS; multivariate logistic regression showed that 24 h MAP （P = 0. 02, OR = 1. 065,95% CI： 1. 008- 1. 124） , UA （P = 0. 002, OR = 1. 009,95% CI： 1. 003-1. 015 ）, LDL-C （ P = 0. 117, OR = 1. 877,95% CI： 0. 854- 4. 128）were independent risk factors of OSAHS in resistance hypertensions. Conclusions The presence of metabolic abnormalities is an important marker of OSAHS in patients with resistant hypertension.