男性高血压合并阻塞性睡眠暂停综合征患者动脉弹性与血浆肾素-血管紧张素-醛固酮活性改变的研究  

Arterial stiffness changs and plasma renin-angiotensin-aldosterone in male patients with hypertension and obstructive sleep apnea-hypopnea syndrome

作　　者：唐一平[1,2] 薛颖[1,2] 余振球[1,2] 魏永祥[1,3] 

机构地区：[1]首都医科大学附属北京安贞医院 [2]北京市心肺血管疾病研究所高血压科,100029 [3]北京市心肺血管疾病研究所耳鼻喉科,100029

出　　处：《心肺血管病杂志》2014年第5期683-687,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：北京市卫生局京财科文稿[2013]0779号

摘　　要：目的:了解合并阻塞性睡眠呼吸暂停综合征的中年男性高血压病患者,动脉弹性改变和血浆肾素-血管紧张素-醛固酮活性改变,探讨两者的相互关系,从而对合并睡眠暂停的高血压病患者的针对性治疗提供理论依据。方法:选择中年男性高血压病住院患者276例,进行多导睡眠监测,根据睡眠呼吸暂停低通气指数(AHI)分为原发性高血压(EH)组(n=101)和原发性高血压合并阻塞性睡眠呼吸暂停综合征(EH+OSAS)组(n=175),两组分别测定晨起卧位肾素活性、血管紧张素Ⅱ(AngⅡ)、血浆醛固酮(Ald)、肱-踝动脉脉搏波传导速度(BaPWV),以及24h动态血压监测,观察两组患者血压、心率、肾素-血管紧张素-醛固酮活性及BaPWV的变化。结果:1EH+OSAS组患者血浆肾素活性[EH+OSAS:1.44(0.51,3.27)比EH:1.83(0.32,4.56)μg/L]和血管紧张素Ⅱ[EH+OSAS:54.99(45.07,71.61)比EH:58.89(50.16,65.52)ng/L]均低于EH组(P<0.05),差异有统计学意义;EH+OSAS组患者血浆醛固酮[EH+OSAS:0.115(0.096,0.147)比EH:0.106(0.094,0.140)μg/L]高于EH组,差异有统计学意义(P<0.05)。2EH+OSAS组患者左右BaPWV均高于EH组[左BaPWV:EH+OSAS:1 520(1 341,1 667)比EH:1 426(1 284,1 614)cm/s,P<0.05;右BaPWV:EH+OSAS:1 537(1 375,1 690)比EH:1 479(1 304,1 621)cm/s,P<0.05]。3患者睡眠呼吸暂停低通气指数(AHI)与血浆醛固酮浓度及左右BaPWV呈显著正相关。4患者左右BaPWV与醛固酮浓度呈显著正相关,与睡眠监测中最低血氧饱和度和平均血氧饱和度呈显著负相关。结论:1合并阻塞性睡眠呼吸暂停的男性高血压病患者的血浆醛固酮浓度明显升高,其血浆肾素、血管紧张素Ⅱ及醛固酮浓度较单纯高血压组具有明显差异性。2合并阻塞性睡眠呼吸暂停的男性高血压病患者的动脉弹性损害比单纯高血压组更加严重,可能与血浆醛固酮的升高有关。Objective：To investigate the changes of arterial stiffness in related to plasma rennin-angiotensin-aldosterone activity in male patients with hypertension and obstructive sleep apnea syndrome（ OSAS）.Methods： Two-hundred and seventy-six male patients with hypertension were recruited,101 with hypertension alone（ EH group,n = 101） and 175 patients of hypertension coexisted with OSAS（ EH ＋ OSAS group,n = 175）.24 h ambulatory blood pressure measurement（ ABPM）,recumbent plasma renin、angiotensin Ⅱ、aldsterone and brachial pulse wave velocity during daytime were determined. Results： 1EH ＋ OSAS patients had lower plasma renin[EH ＋ OSAS： 1. 44（ 0. 51,3. 27） vs. EH： 1. 83（ 0. 32,4. 56） μg /L,P 0. 05]and angiotensin Ⅱ[EH＋ OSAS： 54. 99（ 45. 07,71. 61） vs. H： 58. 89（ 50. 16,65. 52） ng /L,P 0. 05]; EH ＋ OSAS patients had higher plasma aldsterone[EH ＋ OSAS： 0. 115（ 0. 096,0. 147） vs. EH： 0. 106（ 0. 094,0. 140） μg /L,P 0. 05]. 2BaPWV measured in daytime,was also higher in EH ＋ OSAS than that in EH group[left BaPWV： EH ＋ OSAS： 1520（ 1 341,1 667） vs. EH： 1 426（ 1 284,1 614） cm /s,P 0. 05; right BaPWV： EH ＋ OSAS： 1537（ 1375,1690） vs. EH： 1479（ 1 304,1 621） cm /s,P 0. 05]. 3Recumbent plasma aldsterone levels and BaPWV were all correlated with the severity of OSAS indicated by AHI（ ALL P 0. 05）. 4Plasma aldosterone concentration was significantly correlated with BaPWV; blood oxygen saturation in sleep monitoring and the lowest average blood oxygen saturation were significantly negatively correlated with BaPWV（ All P 0. 01）. Conclusion： 1The plasma aldosterone was significantly increased in male patients with hypertension and obstructive sleep apnea syndrom. The plasma renin,angiotensin Ⅱ and aldosterone level were significantly different compared with essential hypertension patients. 2The increase of arterial stiffness in male patients with hypertension and obstructive sleep apnea syndromwas more severe than ess

关 键 词：高血压 阻塞性睡眠呼吸暂停综合征 肾素 血管紧张素Ⅱ 醛固酮 动脉弹性 

分 类 号：R54[医药卫生—心血管疾病]