阻塞性睡眠呼吸暂停与肾素-血管紧张素-醛固酮系统的相关性  

Correlation between Obstructive Sleep Apnea Syndrome and Renin-Angiotensin-Aldosterone System

作　　者：吴俊宸 黄卓山 朱洁明[1] 刘金来[1] WU Jun-chen;HUANG Zhuo-shan;ZHU Jie-ming;LIU Jin-lai(Department of Cardiovascular Medicine,The Third Affiliated Hospital,Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院心血管内科,广东广州510603

出　　处：《中山大学学报（医学科学版）》2020年第5期802-807,共6页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广州市产业技术重大攻关计划(201802010048)。

摘　　要：【目的】探讨不同程度阻塞性睡眠呼吸暂停(OSAS)的高血压患者肾素、血管紧张素Ⅱ、醛固酮的水平是否与血压水平相关。【方法】选取2018年11月至2019年12月在中山大学附属第三医院心内科住院的初次诊断为高血压并完善了睡眠呼吸监测的患者,排除继发性高血压、NYHAⅡ-Ⅳ级心力衰竭、停用影响RAAS激素水平药物未达1月的患者。OSAS的严重程度采用阻塞性睡眠呼吸暂停低通气指数(AHI)表示,检测患者卧位血浆肾素浓度、血管紧张素Ⅱ和醛固酮水平,记录患者入院后使用降压药前所测量的血压。根据AHI水平将患者分为两组,其中A组AHI<15,代表无或轻度OSAS患者,B组AHI≥15,代表中重度OSAS患者。对比两组患者卧位的肾素、血管紧张素Ⅱ、醛固酮水平以及用药前血压的差异。通过线性相关分析与多因素分析,探究OSAS严重程度与RAAS、血压的相关性。【结果】线性相关分析显示,AHI与醛固酮(rs=0.215,P=0.011)、肾素(rs=0.233,P=0.006)、ANGⅡ(rs=0.138,P=0.004)存在正相关性;AHI与收缩压(rs=0.306,P<0.001)、平均动脉压(rs=0.263,P=0.002)存在正相关性;收缩压与肾素(rs=0.288,P=0.001)存在正相关性;舒张压与肾素(rs=0.213,P=0.012)存在正相关性。进一步经多因素校正后醛固酮仍与AHI正相关(β=0.160,P=0.035)。【结论】OSAS严重程度与RASS激活密切相关,特别是与醛固酮水平相关。OSAS主要影响患者的收缩压和平均动脉压。醛固酮受体拮抗剂对于此类高血压患者的血压控制可能更好。【Objective】To explore the association between blood pressure and the plasma levels of renin,angioten⁃sinⅡand aldosterone in hypertensive patients with different degrees of obstructive sleep apnea syndrome(OSAS).【Methods】Patients with secondary hypertension,NYHAⅡ-Ⅳheart failure,and stopping drugs which can affect reninangiotensin-aldosterone system(RASS)for less than 1 month were excluded.Patients who were initially diagnosed as hypertension and completed polysomnography were conducted in the Third Affiliated Hospital of Sun Yat-sen University from November 2018 to December 2019.Apnea-Hypopnea Index(AHI)represents the severity of OSAS.Patients were measured plasma levels of renin concentration,angiotensinⅡand aldosterone in supine positions.Blood pressure before therapy was also recorded.Subjects were divided into two groups based on AHI.Group A included no or mild OSAS patients with AHI<15 and Group B included moderate or severe OSAS patients with AHI≥15.The above indicators were compared between the two groups.We also tried to find the correlation of OSAS,blood pressure and RASS by linear correlation and multiple linear regressions.【Results】Positive correlations were found between AHI and aldosterone(rs=0.215,P=0.011),AHI and plasma renin concentration(rs=0.233,P=0.006),AHI and ANGⅡ(rs=0.138,P=0.004),AHI and systolic blood pressure(rs=0.306,P<0.001),AHI and mean arterial blood pressure(rs=0.263,P=0.002),systolic blood pressure and plasma renin concentration(rs=0.288,P=0.001),diastolic blood pressure and plasma renin concentration(rs=0.213,P=0.012).After adjusting for other variables,aldosterone was also significantly associated with AHI(β=0.160,P=0.035).【Conclusions】OSAS severity is related to RASS,especially to aldosterone.OSAS mainly affects systolic blood pressure and mean arterial blood pressure.Aldosterone receptor antagonist may be more available for hypertensive patients with OSAS.

关 键 词：阻塞性睡眠呼吸暂停 高血压 肾素 血管紧张素Ⅱ 醛固酮 

分 类 号：R5[医药卫生—内科学]