同型半胱氨酸和血压波动对高血压合并阻塞性睡眠呼吸暂停低通气综合征患者的预测价值  

Predictive value of homocysteine and blood pressure fluctuations in hypertensive patients with obstructive sleep apnea hypopnea syndrome

作　　者：吴巧珍[1] 陆燕芳 王伟[1] 吕贤兰 陈慧[1] Wu Qiaozhen;Lu Yanfang;Wang Wei;Lu Xianlan;Chen Hui(Department of Respiratory Medicine,Affiliated Wujiang Hospital of Nantong University/the Ninth People′s Hospital of Suzhou,Suzhou 215200,China)

机构地区：[1]南通大学附属吴江医院,苏州市第九人民医院呼吸内科,苏州215200

出　　处：《中华医学杂志》2020年第28期2192-2197,共6页National Medical Journal of China

基　　金：苏州市科技发展计划(SYS2018001)。

摘　　要：目的探讨同型半胱氨酸(Hcy)和血压波动对高血压合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的预测价值。方法以732例2015年1月至2018年12月因"鼾症"就诊于南通大学附属吴江医院(苏州市第九人民医院)睡眠中心并经多导睡眠图(PSG)监测确诊为OSAHS的高血压病患者为研究对象,根据监测结果分为轻、中、重度OSAHS组各103、150、479例;另以同期经PSG监测呼吸暂停低通气指数<5次/h的55例高血压病鼾症患者作为单纯鼾症组。记录睡眠呼吸监测相关指标,分析四组患者睡眠前后血压变化。采用酶循环法测定轻、中、重度OSAHS组患者各40例和单纯鼾症组20例的血清Hcy水平,分析Hcy与睡眠监测指标及血压波动的关系。结果重度OSAHS组睡眠后舒张压均高于轻、中度OSAHS组和单纯鼾症组[(92.6±11.7)比(88.5±8.1)、(90.2±10.5)和(86.2±11.0)mmHg(1 mmHg=0.133 kPa)],重度OSAHS组睡眠后脉压差低于轻度OSAHS组[(44.7±14.4)比(48.9±14.8)mmHg],均P<0.05。中、重度OSAHS组睡眠后收缩压均高于睡眠前[(134.9±15.9)比(132.5±16.1)、(137.2±16.6)比(134.1±15.2)mmHg],睡眠后脉压差均低于睡眠前[(44.7±12.7)比(47.7±13.5)、(44.7±14.4)比(47.6±12.8)mmHg],均P<0.05;轻、中、重度OSAHS组睡眠后舒张压均高于睡眠前的(86.3±8.4)、(85.5±13.3)、(86.5±11.5)mmHg,均P<0.05。各OSAHS组血清Hcy水平均高于单纯鼾症组[(25.8±10.9)、(29.3±10.8)、(34.0±11.4)比(17.3±13.5)μmol/L],均P<0.05,且随着疾病程度的加重呈逐渐升高趋势。OSAHS患者血清Hcy与睡眠前后舒张压差(ΔDBP)呈正相关(r=0.290,P=0.001),与最低血氧饱和度呈负相关(r=-0.554,P<0.001)。受试者工作特征(ROC)曲线显示,ΔDBP诊断价值为1 mmHg,判断高血压病患者合并OSAHS的灵敏度和特异度分别为70.8%和70.0%;将Hcy和ΔDBP作为联合指标,ROC曲线下面积为0.813,灵敏度和特异度分别为92.5%和65.0%。结论血清Hcy和睡眠前后舒张压波动对高血压病�Objective To explore the predictive value of homocysteine(Hcy)and blood pressure fluctuation in patients with hypertension complicated with obstructive sleep apnea hypopnea syndrome(OSAHS).Methods Seven hundred and thirty-two patients with hypertension and OSAHS undergoing overnight full polysomnography(PSG)were included from Sleep Disorders Center at Affiliated Wujiang Hospital of Nantong University(the Ninth People′s Hospital of Suzhou)between January 2015 and December 2018.According to the monitoring results,they were divided into mild group(n=103),moderate group(n=150)and severe group(n=479)and they were compared with the snoring controls(n=55).The PSG variables were recorded and the blood pressure changes before and after sleep were analyzed.Serum Hcy of 40 patients with mild,moderate and severe OSAHS and 20 patients with snoring was measured by enzymatic cycling methods,and the relationships between Hcy and PSG results and blood pressure fluctuation were analyzed.Results Post-sleep diastolic blood pressure(DBP)in the severe OSAHS group was higher than that in the mild,moderate OSAHS group and snoring control[(92.6±11.7)vs(88.5±8.1),(90.2±10.5),(86.2±11.0)mmHg(1 mmHg=0.133 kPa)],post-sleep pulse pressure(PP)in the severe OSAHS group was lower than that in the mild[(44.7±14.4)vs(48.9±14.8)mmHg](all P<0.05).Post-sleep systolic blood pressure(SBP)in the moderate and severe OSAHS groups was higher than pre-sleep SBP[(134.9±15.9)vs(132.5±16.1),(137.2±16.6)vs(134.1±15.2)mmHg],and post-sleep PP was lower than pre-sleep PP[(44.7±12.7)vs(47.7±13.5),(44.7±14.4)vs(47.6±12.8)mmHg](all P<0.05).Post-sleep DBP was higher than pre-sleep DBP[(86.3±8.4),(85.5±13.3),(86.5±11.5)mmHg]in the mild,moderate and severe OSAHS groups(P<0.05,separately).The concentrations of Hcy in the mild,moderate and severe groups were higher than those in the snoring controls[(25.8±10.9),(29.3±10.8),(34.0±11.4)vs(17.3±13.5)μmol/L](all P<0.05)and there was a trend of increase with the aggravation of the disease.Correlation an

关 键 词：睡眠呼吸暂停 阻塞性 高血压 缺氧 血压波动 同型半胱氨酸 

分 类 号：R766[医药卫生—耳鼻咽喉科] R544.1[医药卫生—临床医学]