高血压病合并阻塞性睡眠呼吸暂停综合征患者血浆同型半胱氨酸水平的临床观察

目的 探讨阻塞性睡眠呼吸暂停综合征（OSAHS）与高同型半胱氨酸血症（hHcy）的相互关系，以及两者与胰岛素抵抗（IR）的作用机制。方法 随机选择300例住院的高血压病患者，男228例，女72例，根据睡眠呼吸暂停及低通气指数（AHI）分成4组：对照组59例（Ⅰ组），轻度OSAHS组89例（Ⅱ组），中度OSAHS组85例（Ⅲ组），重度OSAHS组67例（Ⅳ组）。所有患者均测量身高、体质量、腰围、血压、血脂、空腹血糖、空腹胰岛素、血肌酐和血浆同型半胱氨酸（tHcy）水平。进行4组间各变量比较分析。结果 四组中男性患者所占比例均高于女性患者（P〈0.01）。重度OSAHS患者的体质量指数、腰围、收缩压和舒张压水平明显高于对照组、轻度与中度OSAHS组（P〈0.01）。重度OSAHS患者的空腹胰岛素、稳态模型胰岛素抵抗指数（HOMA-IR）和tHcy明显高于对照组及轻度OSAHS患者（P〈0.01）。重度OSAHS患者的空腹血糖明显高于对照组（P〈0.05）。OSAHS患者的低密度脂蛋白胆固醇均较对照组增高（P〈0.05）。多元回归分析表明AHI与腰围、tHcy、HOMA-IR呈正相关；腰围和tHcy与HOMA-IR呈正相关，与最低氧饱和度呈负相关。结论 tHcy在高血压病合并OSAHS时具有升高的趋势，且随着阻塞程度的进展而加重。IR与OSAHS以及hHcy密切相关。重度OSAHS高血压病患者的代谢综合征表现较为突出。

Association of total plasma homocysteine and obstructive sleep apnea-hypopnea syndrome in hypertension

Objective We observed the clinical characteristics and hyperhomocysteinemia （hHcy） in obstructive sleep apnea/hypopnea syndrome （OSAHS） patients with hypertension and want to investigate the relationships among OSAHS,hHcy and insulin resistant （IR）.Methods We recruited 300 patients who were hospitalized in our department.The subjects underwent polysomnography and according to apnea-hypopnea index （AHI） they were divided into four groups：59 patients served as control.89 patients were in mild OSAHS group.85 patients were in moderate OSAHS group.67 patients were in severe OSAHS group.All of them underwent measurements including height,weight,waist circumference（WC）,systolic blood pressure（SBP）,diastolic blood pressure（DBP）,creatinine（Cr）,fasting plasma glucose（FPG）,fasting plasma insulin（FIns）,total cholesterol（TC）,high density lipoprotein-cholesterol（HDL）,low density lipoprotein-cholesterol（LDL）,triglyceride（TG） and total plasma homocysteine （tHcy）.Results Male patients had more opportunities to suffer OSAHS than female（P〈0.01）.Patients in severe OSAHS group had higher levels of BMI,WC,SBP,DBP than that in control,mild OSAHS group and moderate OSAHS group（P〈0.01）.They also had higher levels of FIns,HOMA-IR and tHcy than that in control and mild OSAHS group（P〈0.01）.Their level of FPG was higher than that in control（P〈0.05）.Patients with OSAHS had higher level of LDL than that in control（P〈0.05）.Multiple linear regression analysis showed that AHI was positive correlation with WC,tHcy and HOMA-IR;WC and tHcy were positive correlation with HOMA-IR while they also were negative correlation with MSpO2.Conclusions Hypertensive patients with OSAHS have more chances to suffer with hHcy.There are closed relationship among OSAHS,IR and hHcy.OSAHS is associated with metabolic syndrome that includes obesity,hyperlipemia and hypertension.