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老年高血压病并发阻塞性睡眠呼吸暂停综合征患者 血压特点及与炎症因子的关系(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2008年第5期
页码:
574-576,587
栏目:
临床研究
出版日期:
2008-10-20

文章信息/Info

Title:
Character of blood pressure variability and inflammatory factors in senile patients with hypertension and obstructive sleep apnea
作者:
刘志; 华琦; 李东宝; 谭静; 朱宏旭
首都医科大学宣武医院心脏科，北京 100053
Author(s):
LIU Zhi;  HUA Qi;  LI Dong Bao;  TAN Jing;  ZHU Hongxu
Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
关键词:
高血压; 阻塞性睡眠呼吸暂停综合征; 血压昼夜节律; 脉压; 炎症因子
Keywords:
hypertension;  obstructive sleep apnea;  blood pressure variability;  pulse pressure;  inflammatory factors
分类号:
R541.4
DOI:
-
文献标识码:
A
摘要:
目的 研究并发中重度阻塞性睡眠呼吸暂停综合征（obstructive sleep apnea syndrome，OSAS）的老年高血压患者血压的变化情况及炎症因子的水平，从而揭示此类患者的疾病特点。方法 将60例年龄大于60岁的研究对象根据诊所血压、24 h动态血压和多导睡眠图监测结果分为单纯高血压病组（n＝30）和并发OSAS组（高血压病并发中重度睡眠呼吸暂停综合征，n=30）。用ELISA法测定白介素-6（IL-6）、sCD40L、超敏C反应蛋白（hs-CRP）、可溶性细胞间黏附分子1（ICAM-1）及血管细胞黏附分子1（VCAM-1）的浓度。结果 ①并发OSAS组中非杓型血压的发生率为67％，明显高于单纯高血压组的发生率37％（P<005）。②并发OSAS组24 h、白天、夜间平均脉压(mean arterial blood pressure,MAP)分别为（51±13）mmHg(1 mmHg=0133 kPa),（50±13）mmHg和（51±17）mmHg均明显高于单纯高血压组（45±7）mmHg，（46±8）mmHg和（44±6）mmHg，并有统计学意义（P<0.05）。③并发OSAS组的IL-6、sCD40L、hs-CRP、ICAM-1、VCAM1浓度明显高于单纯高血压组。④并发OSAS组的hsCRP、ICAM1、VCAM-1浓度变化与呼吸紊乱指数、睡眠血氧下降程度正相关（r=0.852,P<0.05）。 hs-CRP与MAP呈正相关（P<0.01），ICAM-1与夜间血压下降率呈负相关（P<0.05）。结论 中重度睡眠呼吸暂停影响老年人血压昼夜节律的变化，同时对脉压产生明显影响，炎症反应也明显加重。
Abstract:
AIM To study the character of blood pressure variability and inflammatory factors in the senile hypertensive patients with moderate or severe obstructive sleep apnea syndrome (OSAS). METHORDS Sixty elderly patients (>60 year) were divided into hypertension group (n=30) and hypertension with OSAS group (n=30) by the results of clinical blood pressure, 24 h ambulatory blood pressure morning (ABP) and polysomnography (PSG). The serum levels of IL6, sCD40L, hsCRP, ICAM1 and VCAM1 were measured by ELISA. RESULTS ① The rate of nondipper profile of OSAS group (67％) was significantly higher than that of HT group (37％). ② Mean pulse pressure (PP) of 24 h, daytime, and nighttime in OSAS group was（51±13）mmHg(1 mmHg=0133 kPa), (50±13）mmHg, and (51±17）mmHg, which were significantly higher than those of HT group (respectively (45±7)mmHg, (46±8)mmHg, (44±6)mmHg, P<0.05）. ③ The serum level of IL-6, sCD40L, hs-CRP, ICAM-1 and VCAM1 in OSAS group was higher than that of HT group and health group (P<0.05). ④ The serum level of IL6, sCD40L, hsCRP, ICAM1and VCAM-1 of HT group was higher than that of health group. The serum level of hsCRP, ICAM-1 and VCAM-1 was positively correlated with apneahypopnea index（AHI） (P<0.01). The serum level of hsCRP was correlated positively with mean arterial blood pressure（P<0.01）. ICAM1 was negatively correlated with the nighttime decrease of blood pressure（P<0.05）. CONCLUSION Moderate and severe OSAS affects the rhythm of blood pressure variability and pressure pulse in senile patients. OSAS may aggravate HT through inflammatory reaction.

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备注/Memo

备注/Memo:
收稿日期：2008-05-27.基金项目:北京市自然科学基金项目资助(7072032) 通讯作者:华琦，教授，主要从事高血压、冠心病的研究Email:huaqi5371@medmail.com.cn 作者简介：刘志，医师，博士生Email:liuzhi7742@sina.com
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