高原慢性肺心病合并OSAHS患者血管内皮功能的变化及其与肺动脉高压的关系  

The changes of vascular endothelial function and its relation with pulmonary arterial hypertension in patients with chronic cor pulmonale associated obstructive sleep apnea-hypopnea syndrome in high altitude area

作　　者：冯恩志[1] 杨生岳[1] 闫自强[1] 祁玉曙[1] 贺巍[1] 赵丽红[1] 张瑛[1] 

机构地区：[1]解放军第四医院兰州军区呼吸内科中心,青海西宁810007

出　　处：《临床肺科杂志》2011年第10期1504-1506,共3页Journal of Clinical Pulmonary Medicine

摘　　要：目的探讨高原肺心病(HACCP)合并OSAHS患者血管内皮功能的变化及其与肺动脉高压(PAH)的关系。方法 36例HACCP合并OSAHS患者和45例单纯HACCP患者测定了睡眠呼吸暂停低通气指数(AHI)、平均氧饱和度(MSaO2)、平均最低氧饱和度(MmSaO2)、睡眠SaO2<80%占总睡眠时间百分比(T80)、夜间基础与最低氧饱和度之差(△SaO2)、平均肺动脉压(mPAP)、血浆内皮素-1(ET-1)、血清一氧化氮(NO)和肿瘤坏死因子-α(TNF-α),并与40例当地健康人对比。结果 HACCP合并OSAHS组、单纯HACCP组与对照组比较,ET-1、TNF-α、mPAP、ET-1/NO比值升高,NO降低(均P<0.01)。HACCP合并OSAHS组与单纯HACCP组比较,ET-1、TNF-α、mPAP、ET-1/NO比值显著升高,NO显著降低(均P<0.01)。HACCP合并OSAHS组MSaO2、MmSaO2显著低于单纯HACCP患者(均P<0.01),AHI、T80、△SaO2显著高于单纯HACCP患者(均P<0.01)。结论单纯HACCP及HACCP合并OSAHS患者均存在明显的血管内皮损伤,内皮功能失调在HACCP合并OSAHS患者中更明显,且与其PAH的发生密切相关。Objective To assess the changes of vascular endothelial function and its relation with pulmonary arterial hypertension（PAH） in patients with chronic cor pulmonale（HACCP） associated obstructive sleep apnea-hypopnea syndrome（OSAHS） in high altitude area.Methods Apnea-hypopnea index（AHI）,sleep mean oxyhemoglobin saturation（MSaO2）,mean minimum SaO2（MmSaO2）,percentage of the time that SaO2〈80% during sleep（T80）,difference between basic and minimum SaO2 during sleep（△SaO2）,mean pulmonary arterial pressure（mPAP）,plasma endothelin-1（ET-1）,serum nitric oxide（NO） and tumor necrosis factor-α（TNF-α） were measured in 36 stable HACCP patients associated OSAHS and in another 45 stable HACCP patients,and the above mentioned parameters were measured in 40 healthy peoples.Results Compared with control subjects,ET-1,TNF-α,mPAP and ET-1/NO ratio were higher in patients with HACCP or HACCP associated OSAHS（all P〈0.01）,and NO was lower in patients with HACCP or HACCP associated OSAHS（all P〈0.01）.ET-1,TNF-α,mPAP and ET-1/NO ratio were higher in patients with HACCP associated OSAHS than those in patients with HACCP（all P〈0.01）,and NO was lower in patients with HACCP associated OSAHS than that in in patients with HACCP（all P〈0.01）.MSaO2 and MmSaO2 were lower in patients with HACCP associated OSAHS than those in patients with HACCP（all P〈0.01）,and AHI,T80,△SaO2 were higher in patients with HACCP associated OSAHS than those in patients with HACCP（all P〈0.01）.ET-1,TNF-α in patients with HACCP associated OSAHS and patients with HACCP were positively correlated with mPAP,AHI,T80 and △SaO2,and negatively correlated with MSaO2 and MmSaO2（all P〈0.01）,and NO was negatively correlated with AHI,T80 and △SaO2,and positively correlated with MSaO2,MmSaO2（all P〈0.01）.Conclusion The endothelial injury exists in patients with HACCP associated OSAHS and patients with HACCP.The endothelial dysfunction is more obvious in patients with HACCP associa

关 键 词：肺心病 阻塞性睡眠呼吸暂停低通气综合征 内皮素-1 一氧化氮 肿瘤坏死因子-α 高原 

分 类 号：R541.5[医药卫生—心血管疾病] R56[医药卫生—内科学]