睡眠呼吸暂停相关性高血压颈动脉硬化的危险因素  

The risk factors of carotid atherosclerosis in sleep apnea-related hypertension

作　　者：程维平[1] 李南方[1] 严治涛[1] 洪静[1] 汪迎春[1] 李涛[1] 

机构地区：[1]新疆维吾尔自治区人民医院高血压中心新疆高血压研究所,乌鲁木齐830001

出　　处：《中华内科杂志》2011年第12期1026-1029,共4页Chinese Journal of Internal Medicine

摘　　要：目的 调查睡眠呼吸暂停相关性高血压中颈动脉粥样硬化及不稳定斑块的患病率及影响因素.方法 603例诊断为睡眠呼吸暂停相关性高血压入选病例组,根据睡眠呼吸紊乱指数（AHI）进一步分为轻（AHI 5～15）、中（AHI 15～30）、重（AHI≥30）3组,AHI＜5者为对照组.根据颈动脉超声判断斑块性质.结果 4组间性别不匹配；颈动脉粥样硬化在中、重度组高于对照组（P＜0.01）,不稳定斑块在组间无差异；对该人群颈动脉粥样硬化可能的危险因素进行因子分析,共提取6个公因子,以各因子得分为因变量进入逐步logistic回归,提示阻塞性睡眠呼吸暂停、血脂（ TC、LDL-C）为颈动脉粥样硬化的危险因素,OR分别为1.36（95％ CI 1.15～1.59）、1.31 （95％ CI1.12～1.54）,血脂为不稳定斑块的危险因素,OR为1.30（95％ CI 1.06～ 1.58）.结论 睡眠呼吸暂停相关性高血压中颈动脉粥样硬化可能与阻塞性睡眠呼吸暂停独立相关,而不稳定斑块形成则主要与脂代谢紊乱有关.Objective To investigate the risk factors and morbidity of carotid atherosclerosis （CA） and unstable plague in patients with sleep apnea-related hypertension （SA-RH）.Methods A total of 603 SA-RH subjects screened by polysomnography according to apnea hypopnea index （AHI） were recruited and divided into 3 groups：mild （AHI 5-15 ）,moderate （AHI 15-30） and severe （AHI ≥ 30） group,with hypertensive patients with AHI less than 5 served as control.CA was determined by doppler ultrasound as formation of plaque and/or intima-media thickness more than 0.9 mm.Unstable atheroma plaque （UAP） was defined as low echo plaque and/or admixing echo plaque.Results Gender,age,BMI and blood pressure were not matched among groups.The prevalence of CA increased in moderate and severe SA-RH than that in control （ P 〈 0.01 ） with no significant difference for UAP among groups.Factor analysis was performed to extracted common factors that may influence CA and UAP,such as factor 1-6,represent obstructive sleep apnea （OSA）,dyslipidemia （TC,LDL）,BMI,blood pressure,age and duration of disease and dyslipidemia （TG,HDL） respectively.Logistic analysis show that OSA and dyslipidemia （TC,LDL） increased the risk of CA,with OR 1.36（95% CI 1.15-1.59）,1.31 （95% CI 1.12-1.54）respectively,and dyslipidemia （TC,LDL） increased the risk of UAP,with OR 1.30 （95% CI 1.06-1.58）.Conclusions In SA-RH populations,higher prevalence of CA may be associated with severity of OSA independently,meanwhile the formation of UAP may be mainly associated with dyslipidemia.

关 键 词：睡眠呼吸暂停 阻塞性 高血压 动脉硬化 

分 类 号：R544.1[医药卫生—心血管疾病] R543.4[医药卫生—内科学]