本文選題：阻塞性睡眠呼吸暫停低通氣綜合征 + 軟腭��； 參考：《安徽醫(yī)科大學》2014年碩士論文

【摘要】：目的研究阻塞性睡眠呼吸暫停低通氣綜合征（obstructive sleep apnea/hypopneasyndrome，OSAHS）患者上氣道阻塞的部位，研究阻塞部位除了解剖學因素參與OSAHS的發(fā)生，是否還存在神經肌肉調節(jié)的異常參與了OSAHS的發(fā)生。方法1.選擇經我院PSG(Polysomnography，多導睡眠監(jiān)測)診斷的100例OSAHS患者行常規(guī)的體格檢查，例如身高、體重、頸圍、是否有頜面結構異常，專科檢查，例如鼻咽、口咽、喉咽等處是否有解剖學上的阻塞，纖維鼻咽喉鏡檢查結合Muller實驗，上氣道CT掃描范圍為環(huán)狀軟骨到鼻咽頂等明確患者上氣道易發(fā)生阻塞的部位。2.選擇30例經我院PSG檢查診斷為OSAHS的患者作為實驗組，10例經PSG檢查排除OSAHS的單純慢性扁桃體炎患者作為對照組。通過HE染色檢測實驗組和對照組軟腭組織中末梢神經的分布，通過免疫組化檢測實驗組和對照組軟腭組織中蛋白基因產物9.5（protein gene product9.5，PGP9.5）、神經細胞黏附因子（neural cell adhesion molecule，NCAM）的表達，PGP9.5、NCAM的表達水平采用累積光密度（integrated optical density，IOD）進行半定量測定。比較實驗組和對照組中PGP9.5及NCAM的IOD的差異及對照組中PGP9.5及NCAM表達水平與AHI的關系。 結果1.常規(guī)�？茩z查：鼻腔結構較正常狹窄者共80例，以鼻中隔偏曲及慢性肥厚性鼻炎較常見。根據Friedman分級，見腭舌關系2°共13例，腭舌關系3°共36例，，腭舌關系4°共51例。纖維鼻咽喉鏡檢查結合Muller實驗：鼻咽部狹窄的共80例，口咽部狹窄中腭后區(qū)氣道狹窄的共98例，單純腭后區(qū)氣道狹窄的共32例，腭后區(qū)狹窄合并舌后區(qū)狹窄66例，單純舌后區(qū)狹窄2例。上氣道CT掃描檢查：鼻咽部狹窄81例，口咽部狹窄中98例腭后區(qū)氣道狹窄，33例單純腭后區(qū)氣道狹窄，65例腭后區(qū)狹窄合并舌后區(qū)狹窄，單純舌后區(qū)狹窄2例。2.（1）實驗組軟腭不同層次組織中末梢神經的分布不同，末梢神經主要分布在黏膜下層、腺體、血管周圍，肌肉組織周圍少量分布；（2）實驗組OSAHS患者軟腭組織中PGP9.5及NCAM表達水平明顯高于對照組，差異具有統(tǒng)計學意義（P0.05）；（3）PGP9.5和NCAM的表達水平與呼吸暫停低通氣指數（AHI）呈正相關（分別為r=0.706，P=0.01；r=0.636，P=0.01）。 結論（1）OSAHS患者最易發(fā)生阻塞的部位為軟腭后區(qū)，舌后區(qū)平面阻塞也占重要比例， OSAHS患者軟腭具有解剖學上的狹窄；（2）常規(guī)�？茩z查、纖維鼻咽喉鏡檢查、上氣道CT檢查結合能更好的確定OSAHS患者上氣道的阻塞部位； （3）OSAHS患者和非OSAHS者軟腭組織中同樣存在末梢神經及神經反射； （4）OSAHS患者軟腭組織中末梢神經的分布及神經肌肉支配存在異常，且與病情嚴重程度密切相關。
[Abstract]:Objective to study the location of upper airway obstruction in patients with obstructive sleep apnea hypopnea syndrome (obstructive sleep apnea / hypopnea syndrome). Method 1. A total of 100 OSAHS patients diagnosed by PSG (polysomnography) were selected for routine physical examination, such as height, weight, neck circumference, abnormal maxillofacial structure, and specialized examinations, such as nasopharynx, oropharynx, etc. If there is anatomic obstruction in laryngopharynx, fiberoptic rhinolaryngoscopy combined with Muller's experiment, the CT scan range of upper airway is from annular cartilage to nasopharynx top. Thirty patients with OSAHS diagnosed by PSG in our hospital were selected as experimental group and 10 patients with simple chronic tonsillitis who were excluded from OSAHS by PSG examination as control group. The distribution of peripheral nerves in soft palate tissue of experimental group and control group was detected by HE staining. The expression of protein gene product 9.5 (protein gene product 9.5 and nerve cell adhesion factor (neural cell adhesion 9.5 in soft palate tissue of experimental group and control group were detected by immunohistochemistry. The expression level of PGP9.5NCAM in soft palate tissue was measured by (integrated optical density (integrated optical). The difference of IOD in PGP 9.5 and NCAM between experimental group and control group and the relationship between PGP 9.5 and NCAM expression level and AHI in control group were compared. Result 1. Routine examination showed that 80 patients with normal nasal stenosis were found to have nasal septum deviation and chronic hypertrophic rhinitis. According to Friedman's classification, there were 13 cases of palatoglossal relation (2 擄), 36 cases of palatoglossal relation (3 擄) and 51 cases of palatoglossal relationship (4 擄). The results were as follows: 80 cases of nasopharynx stenosis, 98 cases of posterior palatine airway stenosis, 32 cases of simple posterior palatine airway stenosis, 66 cases of posterior palatal area stenosis. There were 2 cases of simple posterior lingual stenosis. Ct scan of upper airway: nasopharynx stenosis in 81 cases, oropharyngeal stenosis in 98 cases, posterior palatine area airway stenosis in 33 cases, simple posterior palatine area airway stenosis in 65 cases, posterior palatine area stenosis with posterior lingual area stenosis in 65 cases. (1) the distribution of peripheral nerves in different layers of soft palate in the experimental group was different. The peripheral nerves were mainly distributed in the submucosa, glands, blood vessels, and a small amount of muscle tissue. (2) the expression levels of PGP9.5 and NCAM in soft palate of OSAHS patients in the experimental group were significantly higher than those in the control group (P0.05). The expression levels of PGP9.5 and NCAM were positively correlated with apnea hypopnea index (AHI) (P < 0.05). Conclusion (1) the most likely site of obstruction in OSAHS patients is the posterior soft palate, the posterior lingual area is also an important part, the soft palate has anatomic stricture in OSAHS patients, (2) routine specialized examination, fiberoptic rhinolaryngoscopy examination, Ct examination of upper airway can better determine the location of obstruction of upper airway in OSAHS patients. (3) peripheral nerve and nerve reflex are also present in soft palate tissues of OSAHS patients and non-OSAHS patients. (4) the distribution and neuromuscular innervation of peripheral nerves in soft palate tissue of OSAHS patients were abnormal, and were closely related to the severity of the disease.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R766

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