【摘要】：目的:阻塞性睡眠呼吸暫停低通氣綜合征(obstructive sleep apnea hypopnea syndrome,OSAHS)是臨床上常見的疾病,其發(fā)病機(jī)制復(fù)雜,研究顯示上氣道周圍神經(jīng)病變是OSAHS的發(fā)病原因之一,但機(jī)制尚不明確。本課題通過測(cè)試OSAHS患者和正常對(duì)照組的軟腭黏膜觸覺閾,以及通過對(duì)OSAHS患者和扁桃體良性病變患者的軟腭黏膜組織進(jìn)行病理形態(tài)學(xué)研究,并進(jìn)行比較,以反映OSAHS患者咽部感覺的損傷性病變,為進(jìn)一步探討上氣道周圍神經(jīng)病變?cè)贠SAHS發(fā)生及發(fā)展中的作用提供依據(jù)。方法:1、第一部分以第二軍醫(yī)大學(xué)附屬長海醫(yī)院耳鼻咽喉頭頸外科2015年8月至2016年2月經(jīng)PSG檢查確診的33例不同程度OSAHS患者作為OSAHS組,招募的經(jīng)PSG檢查排除OSAHS的正常志愿者33例作為正常對(duì)照組,對(duì)所有研究對(duì)象手、頰黏膜以及軟腭黏膜的觸覺閾進(jìn)行測(cè)量,并進(jìn)行兩組間比較,采用Mann-Whitney U檢驗(yàn)分析兩組間的差異有無統(tǒng)計(jì)學(xué)意義,同時(shí)分析OSAHS組軟腭黏膜的觸覺閾與AHI的相關(guān)性。2、第二部分也以第二軍醫(yī)大學(xué)附屬長海醫(yī)院耳鼻咽喉頭頸外科2015年6月至2016年2月經(jīng)PSG檢查確診的OSAHS患者作為OSAHS組,共18例。扁桃體良性病變患者作為對(duì)照組,共17例。手術(shù)過程中收集所有研究對(duì)象的軟腭黏膜組織標(biāo)本,石蠟切片后進(jìn)行HE染色和Masson三色染色,光鏡下觀察OSAHS組軟腭黏膜組織的病理形態(tài)學(xué)改變,圖像分析系統(tǒng)對(duì)兩組軟腭黏膜組織的膠原纖維相對(duì)截面積、炎性細(xì)胞數(shù)量進(jìn)行分析,采用t檢驗(yàn)分析兩組間的差異有無統(tǒng)計(jì)學(xué)意義。結(jié)果:1、第一部分研究結(jié)果顯示:OSAHS組與正常對(duì)照組手背部皮膚的觸覺閾比較,經(jīng)Mann-Whitney U檢驗(yàn),統(tǒng)計(jì)量u=468.500,雙側(cè)檢驗(yàn)P=0.323,差異無統(tǒng)計(jì)學(xué)意義(P0.05);OSAHS組與正常對(duì)照組頰黏膜的觸覺閾比較,經(jīng)Mann-Whitney U檢驗(yàn),統(tǒng)計(jì)量u=423.500,雙側(cè)檢驗(yàn)P=0.113,差異也無統(tǒng)計(jì)學(xué)意義(P0.05);而OSAHS組與對(duì)照組軟腭黏膜的觸覺閾比較,經(jīng)Mann-Whitney U檢驗(yàn),統(tǒng)計(jì)量u=333.500,雙側(cè)檢驗(yàn)P=0.007,差異有統(tǒng)計(jì)學(xué)意義(P0.01)。OSAHS組軟腭腹側(cè)黏膜觸覺閾與AHI相關(guān)性分析顯示樣本等級(jí)相關(guān)系數(shù)r_s=0.322,雙側(cè)檢驗(yàn)P=0.068,相關(guān)性無統(tǒng)計(jì)學(xué)意義(P0.05)。2、第二部分研究結(jié)果顯示:與對(duì)照組相比,OSAHS組軟腭黏膜的黏膜層鱗狀上皮細(xì)胞明顯腫脹,形態(tài)不規(guī)則,固有層明顯增厚,黏膜下疏松結(jié)締組織中可見大量炎性細(xì)胞浸潤,膠原纖維增生,脂肪空泡增多18/18(100%)。OSAHS組和對(duì)照組軟腭黏膜組織膠原纖維相對(duì)截面積的比較,差異有統(tǒng)計(jì)學(xué)意義(t=7.762,P0.001);OSAHS組和對(duì)照組軟腭黏膜組織炎性細(xì)胞數(shù)量的比較,差異有統(tǒng)計(jì)學(xué)意義(t=159.829,P0.001)。結(jié)論:OSAHS患者與正常對(duì)照組相比,軟腭黏膜的觸覺閾明顯升高,觸覺功能下降,與扁桃體良性病變患者相比,OSAHS患者軟腭黏膜出現(xiàn)水腫、大量炎性細(xì)胞浸潤以及膠原纖維組織明顯增生等改變,反映出OSAHS患者存在咽部感覺的損傷,并有其組織病理學(xué)的依據(jù),提示上氣道周圍神經(jīng)病變與OSAHS發(fā)生及發(fā)展有關(guān)。
[Abstract]:OBJECTIVE: Obstructive sleep apnea hypopnea syndrome (OSAHS) is a common disease in clinic. The pathogenesis of OSAHS is complex. Studies have shown that upper airway peripheral neuropathy is one of the causes of OSAHS, but the mechanism is still unclear. The palatal tactile threshold and the soft palatal mucosa of OSAHS patients and benign tonsillar lesions were studied and compared in order to reflect the pharyngeal sensory impairment of OSAHS patients. Methods: 1. Thirty-three patients with OSAHS diagnosed by PSG from August 2015 to February 2016 in the Otolaryngology Head and Neck Surgery Department of Changhai Hospital Affiliated to the Second Military Medical University were selected as the OSAHS group. Thirty-three normal volunteers excluding OSAHS by PSG were recruited as the normal control group. Mann-Whitney U test was used to analyze the difference between the two groups. Meanwhile, the correlation between tactile threshold of soft palate mucosa and AHI in OSAHS group was analyzed. 2. The second part was also diagnosed by PSG in the Department of Otolaryngology Head and Neck Surgery, Changhai Hospital Affiliated to the Second Military Medical University from June 2015 to February 2016. Patients with OSAHS were divided into OSAHS group (18 cases) and benign tonsillar lesions (17 cases) as control group (17 cases). Relative cross-sectional area of collagen fibers and the number of inflammatory cells in soft palate mucosa were analyzed. There was no significant difference between the two groups by t-test. Results: 1. The results of the first part of the study showed that the tactile threshold of the back skin of the hand in OSAHS group was compared with that of the normal control group. The statistical value u was 468.500 by Mann-Whitney U test, and the bilateral test P was 0.3. There was no significant difference between the OSAHS group and the normal control group (P 0.05). After Mann-Whitney U test, the statistical value u = 423.500 and the bilateral test P = 0.113, there was no significant difference between the OSAHS group and the control group (P 0.05). However, compared with the soft palate mucosa, the OSAHS group and the control group, the statistical value u = 333.500 and the bilateral test P = 0.113, there was no significant difference (P 0.05). There was no significant difference between OSAHS group and control group (P 0.01). The correlation analysis between OSAHS group and AHI showed that the correlation coefficient of sample rank r_s = 0.322, and bilateral test P = 0.068. The correlation was not statistically significant (P 0.05). The second part of the study showed that the soft palate mucosal squamous epithelial cells in OSAHS group were significantly swollen compared with the control group. There were a lot of inflammatory cells infiltration, collagen fiber proliferation and fat vacuole increase in 18/18 (100%) in loose connective tissue of submucosa. The relative cross-sectional area of collagen fibers in soft palate mucosa of OSAHS group and control group was significantly different (t = 7.762, P 0.001). The number of inflammatory cells in the soft palate of OSAHS patients was significantly higher than that of the normal control group (t = 159.829, P 0.001). Obvious tissue hyperplasia and other changes reflect the presence of pharyngeal sensory impairment in OSAHS patients, and have its histopathological basis, suggesting that upper airway peripheral neuropathy is related to the occurrence and development of OSAHS.
【學(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R766

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