原发性醛固酮增多症合并不同程度阻塞性睡眠呼吸暂停综合征患者的心脏损害  

Cardiac Damage in Patients with Primary Aldosteronism and Different Degrees of Obstructive Sleep Apnea Syndrome

作　　者：郑绍莹 周明双 李雪[1,2] 张芹 赵雅静[1] Zheng Shaoying;Zhou Mingshuang;Li Xue(Hypertension Ward,Kunming Medical University Af filiated Cardiovascular Hospital/Fuwai Yunnan Hospital of Chinese Academy of Medical Sciences,Kunming 650221,China;Kunming Medical University,Kunming 650500,China)

机构地区：[1]昆明医科大学附属心血管病医院/云南省阜外心血管病医院高血压病区,昆明650221 [2]昆明医科大学,昆明650500

出　　处：《华中科技大学学报(医学版)》2025年第2期240-246,共7页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：云南省科技厅-昆明医科大学联合专项(No.202101AY070001-221,No.202101AY070001-222);云南省阜外心血管病医院人才托举计划-学科发展支持计划(No.2024RCTJ-XK002,No.2024RCTJ-XK003)。

摘　　要：目的探讨原发性醛固酮增多症(primary aldosteronism,PA)合并不同程度阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)患者的左心室肥厚情况,并进一步探讨PA合并OSA中影响心室肥厚的因素。方法回顾性分析2021年1月至2022年6月间在昆明医科大学附属心血管病医院治疗的308例PA患者,选取同时期住院的原发性高血压(essential hypertension,EH)患者309例作为对照。根据多导睡眠图结果,将患者分为合并OSA的PA/EH组和不合并OSA的PA/EH组。PA合并OSA患者根据呼吸暂停低通气指数(apnea-hypopnea index,AHI)结果分为轻、中、重度的OSA。比较各组间的基本资料、生化指标和超声心动图结果。结果PA合并OSA组与EH不合并/合并OSA组相比,室间隔舒张期厚度(interventricular septal diastolic thickness,IVSDT)、左心室质量(left ventricular mass,LVM)和左心室质量指数(left ventricular mass index,LVMI)均升高(均P<0.05)。PA/EH合并OSA两组的体重指数(body mass index,BMI)均高于不合并的OSA的PA/EH两组(均P<0.05)。在PA合并OSA的三个亚组中,重度组的左心室舒张末期内径(left ventricular end-diastolic dimension,LEVDD)、IVSDT、左心室后壁舒张期厚度(left ventricular posterior wall diastolic thickness,LVPWDT)和LVM值高于轻度组,差异具有统计学意义(均P<0.05)。结论醛固酮是独立于OSA影响左心室肥厚的危险因素;PA合并OSA患者中,中、重度组的心脏损害程度高于不合并OSA的PA患者,并且随着OSA的严重程度增加而加重。在PA患者中对OSA进行筛查是有必要的,以便对心脏损害进行分层,进行早期治疗。Objective To investigate the characteristics of left ventricular hypertrophy in patients with primary aldosteronism(PA)accompanied by varying severity of obstructive sleep apnea(OSA),and to further identify potential factors contributing to ventricular hypertrophy in this population.Methods A retrospective analysis was performed on 308 patients with PA who received treatment at Kunming Medical University Affiliated Cardiovascular Hospital from January 2021 to June 2022.For comparison,309 hospitalized patients diagnosed with essential hypertension(EH)during the same period were included as the control group.According to polysomnography findings,the patients were categorized into PA/EH with OSA group and PA/EH without OSA group.PA patients with OSA were further stratified into mild,moderate,and severe OSA subgroups based on the apnea-hypopnea index(AHI).Demographic characteristics,biochemical profiles,and echocardiographic parameters were compared across the groups.Results Compared to the EH groups with or without OSA,interventricular septal diastolic thickness(IVSDT),left ventricular mass index(LVM),and left ventricular mass index(LVMI)was increased in PA with OSA group(all P<0.05).The body mass index(BMI)was increased in both the PA with OSA group and EH with OSA group compared to their counterparts without OSA(all P<0.05).Within the three subgroups of PA patients with OSA,left ventricular end-diastolic dimension(LVEDD),IVSDT,left ventricular posterior wall diastolic thickness(LVPWDT),and LVM measurements were increased in severe OSA group compared to the mild OSA group(all P<0.05).Conclusion Aldosterone is an independent risk factor from OSA for left ventricular hypertrophy;In PA patients with OSA,cardiac impairment is severer in the moderate and severe OSA subgroups compared to those without OSA,and the severity of cardiac impairment escalates as OSA severity increases.These findings highlight the necessity of screening for OSA in PA patients to stratify cardiac impairment risk and enable early therapeutic inte

关 键 词：原发性醛固酮增多症 阻塞性睡眠呼吸暂停综合征 心脏损害 

分 类 号：R544.1[医药卫生—心血管疾病] R586.24[医药卫生—内科学]