阻塞性睡眠呼吸暂停严重程度对高血压患者血浆肾素活性及醛固酮浓度的影响  

Effect of Obstructive Sleep Apnea Severity on Plasma Renin Activity and Aldosterone Concentration in Hypertensive Patients

作　　者：骆秦[1] 陶维俊 王梦卉[2] 汪迎春[2] 李南方[2] Weijun;Wang Menghui(Xinjiang Medical University,Xinjiang 830054,China;不详)

机构地区：[1]新疆医科大学,乌鲁木齐830054 [2]新疆维吾尔自治区人民医院高血压诊疗中心、新疆维吾尔自治区高血压研究所,乌鲁木齐830001

出　　处：《医学研究杂志》2019年第11期31-35,共5页Journal of Medical Research

基　　金：国家自然科学基金资助项目(81660139)

摘　　要：目的本研究通过分析不同程度阻塞性睡眠呼吸暂停(OSA)合并高血压患者中血浆肾素活性(PRA)及醛固酮浓度(PAC)的差异,旨在探讨OSA严重程度对高血压患者肾素-血管紧张素-醛固酮系统(RAAS)的影响.方法回顾2008年10月~2010年12月于新疆维吾尔自治区人民医院高血压诊疗中心住院的高血压患者,根据诊断及排除标准纳入290例完成标准状态下PRA、PAC测定以及多导睡眠监测(PSG)的患者,按呼吸暂停低通气指数(AHI)将研究对象分为OSA组(AHI≥5次/小时,n=220)和非OSA组(AHI<5次/小时,n=70),并按AHI水平进一步将OSA患者分为轻、中、重度3个亚组,比较3组间PRA、PAC水平的差异.结果与非OSA组比较,OSA组患者的OSA组患者的年龄、体重指数(BMI)、腹围较高(P<0.05),而PRA及PAC在两组间差异无统计学意义.考虑到年龄对RAAS的潜在影响,进一步分析50岁以下高血压合并OSA患者(n=161),发现PRA水平在轻、中、重度OSA患者中逐步递增,并且在轻度与重度OSA之间比较差异有统计学意义[1.24±0.96ng/(ml·h)vs 1.82±1.18ng/(ml·h),P<0.05];PAC水平在重度OSA患者中也较轻度及中度OSA患者更高,且差异有统计学意义(P<0.05).Spearman相关分析显示,年龄与PRA呈负相关(r=-0.26,P=0.01),AHI与PRA(r=0.24,P=0.002)及PAC(r=0.20,P=0.011)均呈正相关;多元线性回归分析显示:年龄及AHI与PRA独立相关(P<0.05).结论在50岁以下高血压合并OSA患者中,PRA、PAC水平与OSA严重程度呈正相关,并在重度OSA患者中升高最明显,提示OSA可能通过反复夜间低氧激活RAAS,这可能在OSA患者血压升高过程中起重要作用.Objective To investigate the effect of OSA severity on renin-angiotensin一aldosterone(RAAS)in hypertensive patients by comparing the levels of plasma renin activity(PRA)and plasma aldosterone concentration(PAC)in hypertensive patients with different degrees of OSA.Methods The study included 290 patients who hospitalized in Hypertension Center of People's hospital of Xinjiang and measured PRA,PAC under standardized condition,as well as underwent polysomnography(PSG).According to Apnea Hyponea Index(AHI),subjects were divided into OSA group(AHIM≥5 times/h,n=220)and non-OSA group(AHI<5 times/h,n=70),and OSA patients were further divided into mild,moderate and severe subgroups,the differences of PRA,PAC levels between the three subgroups were compared.Results Compared with non-OSA,the OSA group was older and had higher body mass index(BMI),abdominal circumference(P<0.05),while no significant differences of PRA and PAC were found between OSA and non-OSA group.To avoid the potential effect of aging on RAAS,we made further analysis in patients under age of 50 years and found that PRA levels in mild,moderate and severe OSA patients were gradually increasing,and the difference was statistically significant between mild and severe OSA[1.24±0.96ng/(ml·h)vs 1.82±1.18ng/(ml·h),P<0.05].PAC levels of patients with severe OSA were also higher than those with mild and moderate OSA(P<0.05).Spearman correlation analysis showed that age was negatively correlated with PRA(r=-0.26,P=0.01),AHI was positively correlated with PRA(r=0.24,P=0.002)and PAC(r=0.20,P=0.011).Multiple linear regression analysis showed that age and AHI were independently correlated with PRA(P<0.05).Conclusion PRA and PAC levels were positively correlated with OSA severity and were significantly increased in severe OSA in hypertensive patients under age of 50 years,suggesting that OSA may activate RAAS through repeated nocturnal hypoxia,which may play an important role in the pathogenesis of patients with hypertension and OSA.

关 键 词：阻塞性睡眠呼吸暂停(OSA) 血浆肾素活性(PRA) 醛固酮浓度(PAC) 呼吸暂停低通气指数(AHI) 

分 类 号：R544.1[医药卫生—心血管疾病]