OSAHS患者血浆肾上腺髓质素、心钠素水平及心率变异性的变化和意义  

Changes and Significancy of Adrenomedullin,Atrial Natriuretic Polypeptide and Heart Rate Variability in Patients with Obstructive Sleep Apnea-Hypopnea Syndrome

作　　者：王佩芳[1] 胡征[1] 夏国辉[1] 

机构地区：[1]慈溪市人民医院呼吸科,浙江慈溪315300

出　　处：《中国呼吸与危重监护杂志》2009年第6期569-571,共3页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的探讨不同严重程度OSAHS住院患者血浆肾上腺髓质素(ADM)、心钠素(ANP)及心率变异性(HRV)的变化及临床意义。方法纳入75例OSAHS住院患者,其中轻度31例、中度26例、重度18例。均进行同步动态心电图检测,分析相关HRV指标,包括低频功率(LF)、高频功率(HF)、相差>50ms相邻NN间期占NN间期总数的百分比(pNN50)、连续NN间期标准差(SDNN)、连续NN间期差值的均方根(rMSSD)。以放射免疫法测量血浆ADM及ANP水平。结果随着OSAHS患者病情的加重,SDNN、rMSSD、pNN50、LF及HF呈降低趋势,而血浆ADM与ANP水平均呈升高趋势。SDNN、LF、ADM及ANP在三组中差异有统计学意义(P<0.05)。直线相关分析显示SDNN与ADM、ANP均呈负相关(r=-0.423,P<0.05;r=-0.452,P<0.05);LF与ADM亦呈负相关(r=-0.348,P<0.05)。结论OSAHS的病情越严重,HRV越小。HRV反映的交感/迷走神经张力可能与ADM及ANP的体液调节有关。Objective To investigate the changes and clinical relationship of plasma adrenomedullin（ADM）, atrial natriuretic polypeptide （ANP）, and heart rate variability（HRV） in patients with obstructive sleep apnea-hypopnea syndrome （OSAHS）. Methods Seventy-five inpatients with OSAHS were enrolled in this study. According to the apnea hypopnea index （AHI） by polysomnography, the subjects were divided into a mild group, a moderate group, and a severe group. Meanwhile, HRV was screened by dynamic electrocardiogram in sleep laboratory. HRV parameters were obtained including LF （low frequency power） ,HF（ high frequency power）, pNN50 （percentage of NNSO in the total number of N-N intervals）, SDNN（standard deviation of the N-N intervals）, rMSSD （square root of the mean squared differences of successive N-N intervals ）. Plasma levels of ADM/ANP were measured by radioimmunoassay. Results The levels of SDNN （ P 〈0. 05 ）, rMSSD, pNNSO, LF （ P 〈 0.05 ） and HF were gradually reduced, and the levels of ADM （ P 〈 0.05 ） and ANP （P 〈 0. 05 ） were increased with increasing severity of OSAHS. Linear correlation analysis demonstrated that SDNN was negatively correlated with ADM （ r = - 0. 423, P 〈0. 05 ） and ANP （ r = - 0. 452, P 〈 0. 05 ）, and LF was also negatively correlated with ADM （ r = - 0. 348, P 〈 0. 05 ）. Conclusion Lower HRV is associated with more sever OSAHS, and it may be modulated neurohumorally by ADM and ANP.

关 键 词：阻塞性睡眠呼吸暂停低通气综合征 心率变异性 肾上腺髓质素 心钠素 

分 类 号：R56[医药卫生—呼吸系统]