阻塞性睡眠呼吸暂停综合征患者腭咽软组织病理改变

目的 通过研究睡眠呼吸暂停综合征（ｏｂｓｔｒｕｃｔｉｖｅ ｓｌｅｅｐ ａｐｎｅａ ｓｙｎｄｒｏｍｅ，ＯＳＡＳ）腭咽软组织病理改变，探讨咽扩大肌在ＯＳＡＳ发病机理中的作用。方法 对ＯＳＡＳ２７例，鼾症（ｓｉｍｐｌｅ ｓｎｏｒｉｎｇ，ＳＳ）１７例，对照（扁桃体摘除术患者）１５例的悬雍垂及腭咽肌进行ＨＥ、ＡＴＰ酶、还原型辅酶Ⅰ脱氢酶（ＮＡＤＨ－ＴＲ）等染色，观察软组织病理结构改变。结果 悬雍垂中部横截面

Pathologic changes of palatopharyngeal soft tissue in obstructive sleep apnea syndrome]

OBJECTIVE: To study the pathologic changes of palatopharyngeal soft tissues in patients with OSAS. METHODS: Different analyses have been done on uvular muscles (UM) and/or palatopharyngeal muscles (PPM) in patients with OSAS(n = 27), SS(n = 17) and controls (n = 15). The transverse sections were sequentially stained for HE, myofibrillar ATPase, NADH-TR, Lillie Oil Red-O. Ten specimens were evaluated by transmission electron microscopy(TEM). RESULTS: Patients with OSAS have a significantly smaller percentage of muscle in the uvula than that of SS patients (15.0 +/- 3.0 vs 20.3 +/- 5.5), The percentage of muscle is inversely related to the percentage of fibrous tissue in OSAS group (r = -0.75, Y = 42.6 - 0.64X); The total number and area of muscle fibers, the number and area of type I muscle fibers are significantly lower in OSAS than those in SS (800 +/- 345 vs 1200 +/- 360n; 1.10 +/- 0.56 vs 1.70 +/- 0.60 micron 2; 156 +/- 95 vs 360 +/- 225 n; 920 +/- 350 vs 1365 +/- 540 micron 2 respectively); PPM: The percentage of type I muscle fibers within total muscles and its area are significantly lower in OSAS than those in SS and normal controls(20.5 +/- 4.0 vs 34.5 +/- 4.5 n; 20.5 +/- 4.0 vs 35.5 +/- 4.7; 860 +/- 360 vs 1260 +/- 340 micron 2; 860 +/- 360 vs 1350 +/- 370 micron 2; respectively); the muscles from OSAS patients seemed to show neurogenic alterations. Structurally altered fibers shows myofibrillar loss, increased number of vesicles, and rough Z line and so on. CONCLUSION: Our finding suggest that the neurogenic functional disturbance of pharyngeal dilator muscles may play an important role in causing the airway collapse in OSAS.