阻塞性睡眠呼吸暂停综合征合并高血压前期患者细胞黏附分子与左心室几何构型及功能的相关性  

Clinical study of the relationship between cellular adhesion molecules and left ventricular geometry and function in patients with obstructive sleep apnea syndrome and prehypertension

作　　者：邢雪青 王健[1] 葛珊珊[2] 陈耀东 徐琨[1] 李奕莹[1] 郝美芳[1] 张静璇 高峰[1] Xing Xueqing;Wang Jian;Ge Shanshan;Chen Yaodong;Xu Kun;Li Yiying;Hao Meifang;Zhang Jingruan;Gao Feng(Department of Ultrasound,the First Hospital of Shanzi Medical University,Taiyuan 030001,China;Health Management Center,the First Hospital of Shanri Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学第一医院超声科,太原030001 [2]山西医科大学第一医院健康管理中心,太原030001

出　　处：《中华超声影像学杂志》2023年第4期303-310,共8页Chinese Journal of Ultrasonography

基　　金：山西省自然科学基金项目(201901D111361)。

摘　　要：目的探讨阻塞性睡眠呼吸暂停综合征(OSAS)合并高血压前期(pre-HT)患者血清E选择素、细胞间黏附分子1(ICAM-1)、血管细胞黏附分子1(VCAM-1)与左室几何构型和功能的相关性。方法回顾性研究2019年7月至2022年7月就诊于山西医科大学第一医院呼吸与危重症医学科睡眠监测室经多导睡眠监测(PSG)确诊为OSAS,同时为pre-HT的患者462例,选取同期单纯pre-HT患者52例(pre-HT组),单纯OSAS患者73例(OSAS组)作为对照组。将OSAS合并pre-HT患者按左室几何构型分为4组:正常构型(NG)组、向心性重构(CR)组、离心性肥厚(EH)组和向心性肥厚(CH)组。比较6组间一般临床资料、PSG参数、血生化参数、左室结构和功能参数等,应用Pearson相关分析和多因素Logistic回归分析法分析E选择素、ICAM-1、VCAM-1、一般临床资料、PSG参数、血生化参数与左室功能和左室几何构型的相关性。结果①血清E选择素、ICAM-1和VCAM-1浓度从NG、CR、EH到CH组依次增高,以CH增高最为明显(均P<0.05)。此外,各组间年龄、体质指数(BMI)、OSAS严重程度、颈围、腰围、收缩压(SBP)、舒张压(DBP)、空腹血糖(Glu)、最低血氧饱和度(Lowest-SaO_(2))、平均血氧饱和度(Mean-SaO_(2))、血氧饱和度低于90%的时间占总睡眠时间的百分比(T90)、左室舒张末期内径(LVEDd)、室间隔厚度(IVST)、左室后壁厚度(LVPWT)、左室质量指数(LVMI)、相对室壁厚度(RWT)、左室射血分数(LVEF)、二尖瓣口舒张早期血流峰值速度/二尖瓣口舒张晚期血流峰值速度(E/A)、E峰减速时间(DT)、A峰持续时间(AD)、等容舒张时间(IVRT)、整体长轴纵向应变(GLS)等参数差异有统计学意义(均P<0.05)。②Pearson相关分析显示,E选择素与LVEF、E/A、e′、E/e′、IVRT、GLS呈负相关(r=-0.236、-0.131、-0.224、-0.215、-0.285、-0.336,均P<0.05);ICAM-1与LVEF、E、E/A、e′、IVRT、GLS呈负相关(r=-0.130、-0.129、-0.104、-0.351、-0.252、-0.259,均P<0.Objective To investigate the correlations between serum E selectin,intercellular adhesion molecule 1(ICAM-1),vascular cell adhesion molecule 1(VCAM-1)and left ventricular geometry and function in patients with obstructive sleep apnea syndrome(OSAS)combined with prehypertension(pre-HT).Methods A total of 462 patients with pre-HT and OSAS diagnosed by polysomnography(PSG)in the sleep monitoring unit of the Department of Respiratory and Critical Care Medicine at the First Hospital of Shanxi Medical University from July 2019 to July 2022 were restrospectively analysed,and 52 patients with pure pre-HT(pre-HT group)and 73 patients with pure OSAS(OSAS group)in the same period were selected as the control group.OSAS and pre-HT patients were divided into four groups according to left ventricular geometry:normal geometry(NG)group,concentric remodeling(CR)group,eccentric hypertrophy(EH)group and concentric hypertrophy(CH)group.The general clinical data,PSG parameters,blood biochemical parameters and left ventricular structure and function parameters were compared among the six groups.Pearson correlation and multivariate Logistic regression were used to analyze the correlation between E-selection,ICAM-1,VCAM-1,general clinical data,PSG parameters,blood biochemical parameters with left ventricular geometry and function.Results①Serum E selectin,ICAM-1,and VCAM-1 concentrations increased sequentially from the NG,CR,and EH to CH groups,with the most significant increase in CH group(all P<0.05).In addition,there were statistically significant differences in age,body mass index(BMI),OSAS severity,neck circumference,waist circumference,systolic blood pressure(SBP),diastolic blood pressure(DBP),Glu,lowest oxygen saturation(Lowest-SaO_(2)),mean oxygen saturation(Mean-SaO_(2)),percentage of time with oxygen saturation below 90%of total sleep time(T90),left ventricular end-diastolic diameter(LVEDd),interventricular septal thickness(IVST),left ventricular posterior wall thickness(LVPWT),left ventricular mass index(LVMI),relative ventr

关 键 词：超声心动描记术 二维应变 睡眠呼吸暂停 阻塞性 左室几何构型 E选择素 细胞间黏附分子1 血管细胞黏附分子1 

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