本文選題：阻塞性睡眠呼吸暫停低通氣綜合征(OSAHS) + 高血壓病(HT)��； 參考：《河北醫(yī)科大學》2010年碩士論文

【摘要】： 目的：通過檢測阻塞性睡眠呼吸暫停低通氣綜合征(obstructive sleep apnea-hypopnea syndrome, OSAHS)及阻塞性睡眠呼吸暫停低通氣綜合征合并高血壓(obstructive sleep apnea-hypopnea syndrome associated hypertension,OSAHS+HT)患者血清氧化低密度脂蛋白(oxidized low density lipoprotein,OX-LDL)、總抗氧化能力(total-antoxidant capability, T-AOC)水平的變化,研究兩者與OSAHS及OSAHS+HT的相關性,旨在探討OSAHS及OSAHS+HT患者體內氧化損傷及抗氧化情況,以及兩者在OSAHS及OSAHS+HT的病因、發(fā)病機制及病情進展中的作用。 方法：隨機選擇OSAHS患者46例(均為男性),均經(jīng)多導睡眠儀(polysomnography, PSG)監(jiān)測確診,OSAHS的診斷依據(jù)中華醫(yī)學會呼吸病學分會睡眠呼吸疾病學組制定的診斷標準,其中單純OSAHS患者22例,年齡30～55(42.86±7.07)歲,體重指數(shù)20.57～34.72(27.68±3.41)kg/m2。OSAHS+HT患者24例,年齡30～56(41.25±7.70)歲,體重指數(shù)23.66～35.43(29.12±2.49)kg/m2,符合OSAHS診斷標準,并達到《中國高血壓防治指南》高血壓診斷標準,高血壓發(fā)生晚于OSAHS,且排除腎源性、內分泌性等因素引起的繼發(fā)性高血壓；正常對照組24例(均為男性),年齡27～55(40.08±7.47)歲,體重指數(shù)22.31～31.8(27.66±2.04)kg/m2,經(jīng)詢問病史及行Stardust便攜式睡眠監(jiān)測儀初篩檢查,排除OSAHS。三組間年齡和體重指數(shù)無顯著性差異(均p0.05),并除外吸煙、飲酒、飲食及藥物等干擾因素。所有入選對象均除外各種急慢性感染、肝腎疾病、風濕免疫疾病、腦血管疾病、惡性腫瘤、糖尿病、冠心病等。所有入選者在睡眠呼吸監(jiān)測結束,晨醒5分鐘內抽取空腹肘靜脈血4ml,分別采用酶聯(lián)免疫吸附法測定氧化低密度脂蛋白,比色法測定總抗氧化能力。并記錄有關的監(jiān)測指標,包括睡眠呼吸暫停低通氣指數(shù)(apnea hypopnea index, AHI)、血氧飽和度(SaO2)90%時間占總睡眠時間百分比、睡眠呼吸障礙事件時最低SaO2及平均最低SaO2、睡眠呼吸障礙事件總時間占總睡眠時間百分比、睡眠呼吸障礙最長時間。比較正常對照組、OSAHS、OSAHS+HT三組間OX-LDL、T-AOC水平,三組間OX-LDL、T-AOC比較采用方差分析,兩兩比較采用SNK-q檢驗。OSAHS與OSAHS+HT患者的睡眠呼吸監(jiān)測指標比較采用t檢驗,并將OSAHS、OSAHS+HT患者血清OX-LDL、T-AOC水平與睡眠呼吸監(jiān)測指標進行直線相關分析。 結果： 1.正常對照組、OSAHS組、OSAHS+HT組血清OX-LDL、T-AOC比較。1.1血清OX-LDL水平：正常對照組為7.06±0.49mg/dl, OSAHS組為10.84±1.15mg/dl, OSAHS+HT組為12.79±1.13mg/dl。與正常對照組比較,OSAHS組及OSAHS+HT組OX-LDL濃度均升高,OSAHS+HT與OSAHS比較OX-LDL濃度升高更明顯,均有統(tǒng)計學意義(p0.01)。1.2血清T-AOC水平：正常對照組為12.48±1.22U/ml, OSAHS組為10.05±0.7U/ml, OSAHS+HT組為8.56±0.64 U/ml；與正常對照組比較,OSAHS組及OSAHS+HT組T-AOC水平均降低,OSAHS+HT與OSAHS比較T-AOC水平降低更明顯,均有統(tǒng)計學意義(p0.05)。 2. OSAHS+HT與OSAHS兩組睡眠呼吸監(jiān)測指標比較：AHI、SaO290%時間占總睡眠時間百分比、睡眠呼吸障礙事件總時間占總睡眠時間百分比升高,均具有統(tǒng)計學差異(t分別為-5.17,-2.91,-4.11；p0.01,p0.05,p0.05)；睡眠呼吸障礙事件時最低SaO2、平均最低血氧飽和度均降低,且差異具有顯著性,(t分別為4.37,3.89；p0.05,p0.05)；而睡眠呼吸障礙最長時間在兩組間無統(tǒng)計學差異(t=-1.86,p0.05)。 3.血清OX-LDL、T-AOC水平分別與OSAHS及OSAHS+HT患者睡眠呼吸監(jiān)測各項指標行直線相關分析：血清OX-LDL水平分別與OSAHS組、OSAHS+HT組的AHI、SaO290%時間占總睡眠時間百分比、睡眠呼吸障礙事件總時間占總睡眠時間百分比呈正相關。與睡眠呼吸障礙事件時最低SaO2,平均最低血氧飽和度呈負相關,與睡眠呼吸障礙最長時間無相關性。血清T-AOC水平與OSAHS組、OSAHS+HT組的AHI、SaO290%時間占總睡眠時間百分比、睡眠呼吸障礙事件總時間占總睡眠時間百分比呈負相關。與睡眠呼吸障礙事件時最低SaO2,平均最低血氧飽和度呈正相關,與睡眠呼吸障礙最長時間無相關性。 結論： 1.OSAHS患者無論是否合并高血壓,均存在氧化應激及氧化損傷。且OSAHS患者的氧化應激的發(fā)生是獨立于或先于高血壓的發(fā)生而發(fā)展的。 2.OSAHS+HT患者病情更嚴重,缺氧更明顯。氧化應激可能為OSAHS患者發(fā)生高血壓的原因之一。 在OSAHS及OSAHS+HT患者體內均存在氧化抗氧化失衡,且這種失衡在OSAHS+HT患者體內更明顯。OX-LDL、T-AOC在阻塞性睡眠呼吸暫停低通氣綜合征患者血中含量的變化可反映病情的嚴重程度,了解氧化應激的程度,可指導OSAHS的早期治療及改善其預后。
[Abstract]:Objective: to detect the serum oxidized low density lipoprotein (LDL) in patients with obstructive sleep apnea hypopnea syndrome (obstructive sleep apnea-hypopnea syndrome, OSAHS) and obstructive sleep apnea hypopnea syndrome with hypertension (obstructive sleep apnea-hypopnea syndrome associated hypertension, OSAHS+HT). D low density lipoprotein, OX-LDL), the changes in the total antioxidant capacity (total-antoxidant capability, T-AOC), and the correlation of both OSAHS and OSAHS+HT. The purpose of this study is to explore the oxidative damage and antioxidant status of OSAHS and OSAHS+HT patients, as well as their role in the pathogenesis, pathogenesis and progress of the disease.
Methods: 46 patients (all male) were selected randomly, all of them were diagnosed by polysomnography (PSG). The diagnosis of OSAHS was based on the diagnostic criteria of the sleep respiratory disease group of the Chinese Medical Association of respiratory diseases, including 22 cases of simple OSAHS patients, age 30~55 (42.86 + 7.07) years, and body mass index 20.57 to 34.72 (27.68 +). 3.41) 24 cases of kg/m2.OSAHS+HT patients, age 30~56 (41.25 + 7.70) years, body mass index 23.66 to 35.43 (29.12 + 2.49) kg/m2, conformed to the OSAHS diagnostic criteria, and reached < Chinese Hypertension Prevention Guide > hypertension diagnosis standard, hypertension occurred later than OSAHS, and excluded secondary hypertension caused by renal origin, endocrine and other factors; normal control Group 24 (all male), age 27~55 (40.08 + 7.47) years, body mass index 22.31 ~ 31.8 (27.66 + 2.04) kg/m2, after inquiry of medical history and Stardust portable sleep monitor first screening test, exclude the age and body mass index of OSAHS. three groups of no significant difference (all P0.05), except smoking, drinking, diet and drugs and other interference factors. All selected All the subjects were except for all kinds of acute and chronic infection, liver and kidney disease, rheumatic immune disease, cerebrovascular disease, malignant tumor, diabetes, coronary heart disease, etc. all the participants were selected at the end of the sleep breathing monitoring, the 4ml of the empty abdominal vein blood was extracted within 5 minutes in the morning, and the oxidized low density lipoprotein was measured by enzyme linked immunosorbent assay, and the colorimetric assay was used to determine the total antioxidant activity. Ability. And records related monitoring indicators, including the sleep apnea hypopnea index (apnea hypopnea index, AHI), blood oxygen saturation (SaO2) 90%, the percentage of total sleep time, the lowest SaO2 and the mean lowest SaO2 in the sleep apnea event, the percentage of total sleep time, the percentage of total sleep time, and the sleep apnea. The longest time. Compared with the normal control group, OSAHS, OSAHS+HT three groups, OX-LDL, T-AOC level, three groups of OX-LDL, T-AOC compared with variance analysis, 22 compared with SNK-q test.OSAHS and OSAHS+HT patients' sleep breathing monitoring indexes compared to t test, OSAHS, OSAHS serum levels and sleep breathing monitoring indicators The linear correlation analysis is carried out.
Result錛，

本文編號：1963695