重度阻塞性睡眠呼吸暂停低通气综合征合并高血压患者血清心肌酶及尿酸水平的变化

目的 探讨重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并高血压患者血清肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)及尿酸(UA)水平的变化,对比分析OSAHS患者心脏功能异常率。方法 选取经多导睡眠监测确诊为重度OSAHS的患者90例,其中67例为单纯OSAHS组,23例为OSAHS合并高血压组,同时选取30例原发性高血压患者为单纯高血压组、20例健康查体人员为对照组,测定四组人群CK、CK-MB、LDH及UA水平,并对两组OSAHS患者心脏结构和功能异常率进行对比分析。结果 与对照组相比,单纯OSAHS组、OSAHS伴高血压组的CK、CK-MB、LDH、SUA明显升高(P<0.05或P<0.01);与单纯OSAHS组相比,OSAHS伴高血压组的CK、LDH、SUA明显升高(P<0.05),但CK-MB差异无统计学意义(P>0.05)。OSAHS伴高血压组左心室向心性肥厚、室间隔增厚、左心房增大、主动脉瓣返流、E/A<1的发生率均明显高于单纯OSAHS组(P<0.05或P<0.01)。相关分析显示,OSAHS患者的CK、LDH、SUA均与AHI呈正相关,且与SpO₂呈负相关(P<0.05或P<0.01);CK-MB与AHI、SpO₂无明显相关(P>0.05)。结论 重度OSAHS患者血清心肌酶及尿酸水平有不同程度的升高,且若合并高血压则尿酸及部分心肌酶升高更明显;重度OSAHS患者的心脏结构和功能有一定的异常率,且合并高血压会明显升高此概率;尿酸及CK、LDH与OSAHS病情严重程度及缺氧程度相关。

Changes of serum myocardial enzymes and uric acid in patients with severe obstructive sleep apnea hypopnea syn-drome complicated with hypertension

Objective To explore the levels of creatine kinase (CK), creatine kinase isoenzyme (CK-MB), lactate dehydrogenase (LDH) and uric acid (UA) in patients with severe obstructive sleep apnea hypopnea syndrome (OSAHS) complicated with hypertension. Methods A total of 140 OSAHS cases were divided into simple OSAHS group (n=67) and OSAHS complicated with hypertension group (n=23, OSAHS+HT group), 30 patients with simple hypertension were included into the hypertension group, and 20 healthy people served as controls. The levels of CK, CK-MB, LDH and UA of the 4 groups were measured. The rates of abnormal cardiac structure and function in OSAHS group and OSAHS+HT group were analyzed. Results Compared with the control group, the levels of CK, CK-MB, LDH and UA in the other 3 groups were higher (P<0.05, or P<0.01). Compared with simple OSAHS group, the levels of CK, LDH and UA in OSAHS+HT group were higher (P<0.05), but the level of CK-MB had no significant difference (P>0.05). The incidence of left ventricular hypertrophy, ventricular septal thickening, left atrial enlargement, aortic valve regurgitation and E/A<1 was higher in OSAHS+HT group than in OSAHS group (P<0.05, or P<0.01). The levels of serum CK, LDH and UA in OSAHS patients were positively correlated with AHI, but negatively correlated with SpO₂. There was no significant correlation between CK-MB and AHI, and SpO₂. Conclusion Severe OSAHS patients have increased serum myocardial enzymes and uric acid level. For OSAHS patients complicatedwith hypertension, uric acid and myocardial enzymes will increase more significantly. Patients with severe OSAHS may have abnormal cardiac structure and function, and hypertension may increase this probability. UA, CK and LDH are associated with the severity of OSAHS and degree of hypoxia.