成人阻塞性睡眠呼吸暂停低通气综合征患者腭咽肌的肌肉病理研究  

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

作　　者：陈怀宏[1] 管玉青[2] 谢作善[2] 张威[1] 刘雄[1] 李琦[1] 邓睿[1] 刘小龙[1] 王路[1] 李湘平[1] 

机构地区：[1]南方医科大学南方医院耳鼻咽喉头颈外科,广州510515 [2]南方医科大学南方医院神经内科,广州510515

出　　处：《中华耳鼻咽喉头颈外科杂志》2013年第9期746-751,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：2010南方医院院长青年基金（2010C007）;2012南方医院院长基金（20122003）

摘　　要：目的研究阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者腭咽肌的肌肉病理改变。方法腭咽肌行肌肉病理检查，包括常规苏木精-伊红（HE）染色、还原型辅酶I四氮唑还原酶（nicotinamideadeninedinucleotide—tetrazoliumreductase，NADH—TR）染色，改良Gomori三色（modifiedGomontrichrome，MGT）染色和肌球蛋白三磷酸腺苷酶（ATP酶）染色。实验组为36例接受悬雍垂腭咽成形术治疗的OSAHS患者（轻度组6例，中度组6例，重度组24例），对照组为经多道睡眠监测（PSG）排除OSAHS诊断的6例慢性扁桃体炎患者。结果常规HE染色，两组腭咽肌细胞都存在核内移和肌纤维大小的明显变异，但发生比例不同：核内移对照组为1／6，OSAHS组52．8％（19／36）；肌纤维大小变异性对照组4／6，OSAHS组58．3％（21／36）。在NADH染色中，两组的大部分肌纤维（对照组5／6，OSAHS组28／36）都可以观察到边缘深染不规则分布的氧化酶活性反应染色。OSAHS组显示多种形态的特异性肌肉病理改变，可见分叶状或虫蚀状纤维，靶样纤维，不整红边纤维，肌问质增生明显，单个肌纤维坏死和吞噬。重度组出现病变的比例较轻中度组常见。ATP酶染色中，部分对照组出现Ⅰ型纤维局部优势，而OSAHS组Ⅱ型纤维或两型纤维均呈群组化分布，以重度组明显。部分OSAHS患者出现Ⅱ型纤维优势。结论常规病理观察和肌纤维特殊染色观察证实OSAHS患者存在腭咽肌病理损伤，包括肌纤维内部改变的肌纤维损伤和肌纤维类型分布异常，维持上气道开放的Ⅰ型肌纤维比率下降。Objective To investigate the pathology of palatopharyngeal muscle obtained from patients with obstructive sleep apnea hypopnea syndrome （OSAHS）. Methods The samples from both groups were studied under HE, nicotinamide adenine dinucleotide-tetrazolium reductase （NADH- TR）, modified Gomori trichrome （MGT） and adenosine triphosphatase （ATPase） staining. There were 36 cases of OSAHS who received uvulopalatopharyngoplasty in the experimental group （ including 6 mild, 6 moderate and 24 severe cases）. There were 6 patients with chronic tonsillitis but without OSAHS as matched control group. Both groups were diagnosed by PSG. Results Centralized located nuclei and obvious variability of the size of fiber types were observed in both groups. The occurrence rate of the former were 1/6 in control group and 52. 8% （19/36） in OSAHS, while the rate of the latter were 4/6 and 58.3% （21/36） respectively. A large number of fibers in both groups （ control group 5/6, OSAHS group 28/36 ） presented an irregularly distributed staining for oxidative activity reaction in NADH stain. Endomysium connective tissue proliferation, a lobular or motheaten appearance, target-like fibers, ragged red fiber （RRF） and muscle necrosis were only observed in OSAHS group. While it was more common in serious OSAHS patients. Dominance of type 1 fibers were observed in matched control group in ATPase stain. Clusters of type 2 fibers or clusters of both typefibers were observed in OSAHS, especially more common in serious OSAHS. There was a predominance of the type 2 fibers in some OSAHS patients. Conclusions The observation of HE and special muscular stain identified that palatopharyngeal muscle of OSAHS patients had pathological lesion. The pathological changes included muscular lesion and abnormal distribution of different fiber types, the rate of type 1 fiber which maintained the opening of upper air way decreased.

关 键 词：睡眠呼吸暂停 阻塞性 腭肌 显微镜检查 

分 类 号：R766[医药卫生—耳鼻咽喉科]