阻塞性睡眠呼吸暂停低通气综合征合并高血压患者血清巨噬细胞炎症蛋白-1α和高敏C反应蛋白的表达  

Serum macrophage inflammatory protein-1α and high-sensitivity C-reactive protein in patients with obstructive sleep apnea-hypopnea syndrome and hypertension

作　　者：张楠[1] 覃数[1] 张冬颖[1] 杨伊萍[1] 邓琼珍[1] 游小钧[1] 

机构地区：[1]重庆医科大学附属第一医院心内科,重庆400016

出　　处：《第三军医大学学报》2010年第7期696-699,共4页Journal of Third Military Medical University

基　　金：重庆市卫生局课题(渝05-2-159)~~

摘　　要：目的探讨阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea syndrome,OSAHS)对高血压(hyper-tension,HT)患者血清巨噬细胞炎症蛋白-1α(macrophage inflammatory protein-1α,MIP-1α)和高敏C反应蛋白(high-sensitiv-ity c-reactive protein,hs-CRP)水平以及对心脏功能的影响。方法选取经多导睡眠监测仪确诊OSAHS患者、OSAHS合并高血压患者,及经心血管内科初诊原发性高血压患者共86例,分为OSAHS组29例、OSAHS+HT组30例和HT组27例,另设对照组(C组)30例,进行彩色多普勒超声心动图检查,测定血清MIP-1α、hs-CRP浓度。结果HT组、OSAHS+HT组收缩压、舒张压、脉压差均较OSAHS组显著升高(P<0.05)。OSAHS组、OSAHS+HT组、HT组E峰速度(E velocity,EV)均明显低于C组(P<0.05),且OSAHS+HT组、HT组与OSAHS组比较仍有统计学差异(P<0.05)。OSAHS组、OSAHS+HT组、HT组A峰速度(A velocity,AV)均较C组显著升高(P<0.05)。OSAHS+HT组血清MIP-1α水平显著高于HT组(P<0.05)。血清MIP-1α水平与A峰成负相关(r=-0.238,P=0.08),与E/A成正相关(r=0.307,P=0.02)。结论OSAHS能诱导患者血清MIP-1α水平改变,且较血清hs-CRP变化出现更早,如合并高血压病则更为明显;血清MIP-1α水平升高与心脏舒张功能降低相关。ObjectiveTo identify the effects of obstructive sleep apnea-hypopnea syndrome（OSAHS）on serum levels of macrophage inflammatory protein-1α（MIP-1α）and high-sensitivity c-reactive protein（hs-CRP）,and impact on cardiac structure and function in patients with hypertension（HT）.MethodsPolysomnography（PSG）was employed to determine OSAHS,and HT was verified by cardiovascular methods.Totally 86 middle-aged subjects admitted in our hospital from April to December 2008 were classified into 4 groups according to the absence or presence of OSAHS and with or without HT,OSAHS patients without HT（OSAHS group,n=29）,OSAHS patients with HT（OSAHS＋HT group,n=27）,non-OSAHS patients with HT（HT group,n=27）,and health volunteers without OSAHS or HT（control subjects,n=27）.OSAHS patients were divided into mild,moderate and severe degree based on apnea hypopnea index（AHI）.All participants underwent polysomnography and echocardiography.Serum MIP-1α and hs-CRP levels were tested by enzyme linked immunosorbent assay（ELISA）.ResultsSystolic,diastolic blood pressure（SBP,DBP）and pulse pressure difference（PP）in HT group and OSAHS＋HT group were significantly higher than those in OSAHS group.Comparing with control group,the E velocity（EV）was significant decreased and A velocity（AV）was increased significantly in OSAHS,OSAHS＋HT and HT groups（P〈0.05）.Serum MIP-1α levels in OSAHS＋HT group was significant higher than HT groups（P〈0.05）.Serum MIP-1α levels in those 3 groups were negatively correlated with AV（r=-0.238,P=0.08）and positively correlated with E/A ratio（r=0.307,P=0.02）.ConclusionWe have not found the cardiac systolic function change in early OSAHS patients with HT,while the diastolic function is decreased obviously.Serum MIP-1α level shows earlier change than hs-CRP level in OSAHS patients,which may contribute to the lesion of cardiac diastolic function.

关 键 词：巨噬细胞炎症蛋白-1Α 高敏C反应蛋白 睡眠呼吸暂停 阻塞性 高血压 

分 类 号：R544.1[医药卫生—心血管疾病] R563.806[医药卫生—内科学]