阻塞性睡眠呼吸暂停综合征患者多平面手术前后的血压昼夜节律与血清新蝶呤变化  

Circadian blood pressure variability and plasma neopterin level before and after surgery for obstructive sleep apnea syndrome

作　　者：王海玲[1] 陈韵岱[3] 王宇[2] 张颖[2] 王新春[4] 刘至玄[2] 静国丽[1] 佟海峰[1] 田媛[2] 史珂[1] 刘庆增[1] 

机构地区：[1]北京军区总院二六三临床部心血管内科,北京101149 [2]北京军区总院二六三临床部耳鼻咽喉头颈外科,北京101149 [3]中国人民解放军总医院心血管内科 [4]哈尔滨医科大学附属第二医院急诊科

出　　处：《中华心血管病杂志》2011年第2期132-136,共5页Chinese Journal of Cardiology

摘　　要：目的 探讨阻塞性睡眠呼吸暂停综合征（OSAS）患者手术治疗前后的血压昼夜节律与血清新蝶呤的变化。方法 连续入院的拟行手术的OSAS患者382例，行睡眠监测后分为3组，轻度OSAS组206例，中度OSAS组108例，重度OSAS组68例。入院1周内检测血清新蝶呤浓度，并同时行24h动态血压监测，术后3个月复查上述指标。结果 手术前血清新蝶呤浓度轻度OSAS组为15．08nmol/L，中度OSAS组为27．68nmol/L，重度OSAS组为37．32nmo/L，术后三组血清新蝶呤浓度分别为9．92nmol/L、15．07nmol/L和8．54nmol/L，三组比较差异有统计学意义（P〈0．05）。手术前三组昼夜血压曲线呈非杓型分别占50．2％、72．7％和86．5％，术后分别为34．8％、48．2％和49．4％，三组比较差异有统计学意义（P〈0．05）。相关分析表明，血压夜间下降百分率与血清新蝶呤浓度呈负相关。结论 血清新蝶呤浓度及血压非杓型比例与OSAS严重程度相关。血压夜间下降百分率与血清新蝶呤浓度呈负相关。手术治疗后血清新蝶呤浓度及非杓型比例均下降。血清新蝶呤浓度可能在OSAS患者血压变异性的发病机制中起一定作用。手术治疗可改善OSAS的血压变异性并减轻炎症反应。Objective To investigate the change of circadian blood pressure variability （BPV） and plasma neopterin before and after surgey （uvulopalatopharyngoplasty） for patients with obstrcuctive sleep apnea syndrome （ OSAS）. Methods A total of 382 OSAS patients underwent uvulopalatopharyngoplasty were divided into three groups based on polysomnography （PSG） results ： mild OSAS （ n = 206 ）, moderate OSAS （ n = 108 ） and severe OSAS （ n = 68 ） . Plasma neopterin, 24-hour ambulatory blood pressure monitoring （ABPM）, PSG were measured before and 3 months after surgery. Results Plasma neopterin increased in proportion to severity of OSAS before surgery （ 15. 08 nmol/L,27. 68 nmol/L and 37. 32 nmol/L in patients with mild to severe OSAS） which were significantly reduced post surgery （9.92 ng/ml, 15. 07 ng/ml and 18.54 ng/ml, all P 〈0. 05 vs. pre-surgery）. The incidence of non-dipper curve in three OSAS groups were 50.2% ,72.7% and 86.5%, respectively before surgery and the values decreased to 34. 8%, 48.2% and 49. 2% after surgery （all P 〈0. 05 vs. pre-surgery）. Relevance analysis indicates that D-value of nocturnal and diurnal blood pressure was negatively correlated with plasma neopterin. Conclusion Our findings indicated that plasma neopterin and the incidence of non-dipper could reliably reflect OSAS severity and could thus be used to evaluate the surgery efficacy. Plasma neopterin might be an important player in the pathophysiology of OSAS via modulating blood pressure variability.

关 键 词：睡眠呼吸暂停综合征 新蝶呤 血压 

分 类 号：R766[医药卫生—耳鼻咽喉科]