不同程度阻塞性睡眠呼吸暂停低通气综合征患者腭咽肌病理形态的电镜观察  

Pathologic changes of the palatopharyngeal muscles in patients with obstructive sleep apnea hypopnea syndrome of different degrees

作　　者：李赛楠[1] 杨怀安[1] 姜学钧[1] 任重[1] 

机构地区：[1]中国医科大学附属第一医院耳鼻咽喉科,沈阳110001

出　　处：《中华耳鼻咽喉头颈外科杂志》2011年第8期638-641,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的研究不同程度阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome，OSAHS）患者的腭咽肌在透射电镜下的病理形态学改变，探讨腭咽组织在其发病机制中的作用。方法38例接受悬雍垂腭咽成形术治疗的OSAHS患者（轻度组10例，中度组13例，重度组15例），对照组为5例无口咽部阻塞疾病行腭肿物或腭良性肿瘤切除术的成人患者。透射电镜下观察腭咽肌形态变化特点。结果透射电镜下对照组腭咽肌的肌纤维排列规整，肌间线粒体基本正常。OSAHS轻度组腭咽肌的肌原纤维排列规则，z线平直，大多线粒体结构正常；中度组肌纤维走行紊乱，z线距离缩短、扭曲，线粒体大量空泡变性；重度组肌纤维呈点状或片状排列，z线扭曲或消失，细胞器崩解，线粒体呈絮状改变，甚至消失，肌间可见脂质沉积。对照及OSAHS轻、中、重4组腭咽肌的肌纤维排列紊乱的发生比率分别为0、3／10、10／13、15／15，发生线粒体变性的比率为0、2／10、8／13、14／15，均有随病情程度加重而超微结构改变发生率增高的趋势。结论OSAHS病情程度与腭咽肌病理形态变化有关，肌肉病变是OSAHS发病的重要环节，慢性间歇缺氧等病理损害可能进一步加重肌肉病变。Objective To study the pathologic changes of the palatopharyngeal muscles with transmission electronmiscroscopy （TEM） in patients with obstructive sleep apnea hypopnea syndrome （OSAHS）, the role of the above muscle in OSAHS pathogenesis was discussed. Methods Thirty-eight palatopharyngeal muscle from OSAHS patients receiving uvulopalatopharyngoplasty （UPPP） were collected in in-patient department of Chinese Medical University and five palatal tumor patients receiving resection without snoring were chosen as the control. The palatophryngeal muscle fiber and the feature of changes in mitochondrial morphology were observed by TEM. Results The pathological changes were not observed in the normal control group. The muscle fibers were regularly arranged, and the mitochondrial between muscles were normal. The palatopharyngeal myofibrillar in mild OSAHS group was regularly arranged. The Z lines were straight, and most mitochondria structure were normal. In the moderate group, the myofibrillar was disorganized, and the Z lines were shortened or distorted. The myofibrillar in severe group was disorganized, similar to point-like or flake, and the Z lines and the structures of sarcomeres were disppearered. And organelle were disintegrated and mitochondria were disappeared similar to flocculent. There existed obvious fatty infiltration in the palatopharyngeal muscle. In the control, mild, moderate and severe group, pharyngeal muscle fiber disarrangement of the occurrence rate was 0, 2/10, 8/13, 14/15, the occurrence rate of mitochondrial degeneration was 0, 2/10, 8/13, 14/15, increased with the severity of the ultrastructural changes in the trend of increasing incidence. Conclusions The degree of OSAHS is correlated with the pathological changes of palatopharyngeal muscles. Incidence of myopathy is an important part of OSAHS secondary to chronic intermittent hypoxia in OSAHS and other pathological lesions, but also an important reason for increasing pharyngeal collapse.

关 键 词：睡眠呼吸暂停 阻塞性 腭肌 显微镜检查 电子 透射 

分 类 号：R766[医药卫生—耳鼻咽喉科]