目的 探讨阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea hypopnea syndrome, OSAHS)合并高血压患者持续正压通气(continuous positive airway pressure,CPAP)后对血管内皮生长因子(vascular endothelial growth factor, VEGF)的影响。方法 选取47~57岁OSAHS合并高血压患者45例,对所有入选病例进行PSG监测和血压监测,并根据监测的通气结果分组。对所有患者进行CPAP治疗,之后再次行PSG监测和血压监测。考察以下指标:AHI、SaO2、收缩压、舒张压、平均动脉压、血VEGF因子浓度。结果 OSAHS合并高血压患者经CPAP治疗后,PSG监测通气指标均有改善,血压下降;三组治疗后VEGF因子浓度为(40.77±13.19)pg/ml、(41.92±15.84)pg/ml、(56.06±18.91)pg/ml,与三组治疗前VEGF因子浓度相比明显降低,治疗前分别为(52.07±15.82)pg/ml、(74.11±21.20)pg/ml、(92.79±24.03)pg/ml,差异有统计学意义(P<0.05);VEGF浓度与各项指标之间呈现典型的正相关,其中与AHI、SaO2,以及舒张压之间的相关性极为显著。结论 CPAP治疗OSAHS合并高血压患者效果显著,阻塞性睡眠呼吸障碍造成患者体内形成低氧环境,VEGF因子水平显著增高,可诱发血管增生,最终导致高血压形成。
Abstract
Objective To investigate the changes of vascular endothelial growth factors (VEGF) in patients with hypertension and obstructive sleep apnea syndrome (OSAHS) after continuous positive airway pressure (CPAP). Methods Forty-five patients aged 47 to 57 were divided into 3 groups according to results of PSG monitoring and ABP. AHI, SaO2, blood pressure and blood VEGF concentration were observed before and after CPAP therapy. Results After CPAP treatment, PSG index and blood pressure monitoring indicators in OSAHS patients with hypertension were toward the positive direction. VEGF expression decreased significantly; and before treatment, VEGF factor levels in three groups were (52.07±15.82), (74.11±21.20), (92.79±24.03)pg/ml respectively; after treatment, VEGF factor levels in three groups were (40.77±13.19), (41.92±15.84), (56.06±18.91)pg/ml, respectively. There was significant difference in VEGF factor before and after treatment (P<0.05); correlation between VEGF and the remaining indicators was typically positive, and correlations between VEGF and SaO2, AHI, diastolic blood pressure were extremely significant. Conclusions CPAP therapy is significantly effective in treating OSAHS patients with hypertension. OSAHS creats a hypoxia internal environment in the patients. VEGF raises and promotes formation of hypertension.
关键词
OSAHS合并高血压 /
持续性正压通气 /
VEGF因子
Key words
obstructive sleep apnea hypopnea syndrome /
continuous positive airway pressure /
vascular endothelial growth factor
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参考文献
[1] 姜鲁宁. 阻塞性睡眠呼吸暂停综合征的相关影响因素[J]. 山东医药, 2009,49(5):104-105.
[2] 黎燕群,张希龙.持续气道正压通气治疗对阻塞性睡眠呼吸暂停综合征患者难治性高血压的影响 [J].南京医科大学学报(自然科学版),2008,28(2):210-214.
[3] 张 婧, 周云飞, 侯晓平,等. 阻塞性睡眠呼吸暂停综合征对老年糖尿病患者血糖的影响[J]. 武警医学, 2014, 25(1):59-61.
[4] 邹 燕, 吴定志, 谭成芳. 阻塞性睡眠呼吸暂停综合征与高血压[J]. 现代医药卫生, 2011, 13(7):1029-1031.
[5] 李丹青. 阻塞性睡眠呼吸暂停合并高血压男性的心脏结构的变化及持续气道正压通气的影响[D].广州:南方医科大学,2014:32
[6] 朱海东. 睡眠呼吸暂停相关性高血压与原发性高血压血管内皮功能的比较[J]. 武警医学, 2013, 24(10):843-845.
[7] 李丹青, 李涛平, 郭东英,等. 阻塞性睡眠呼吸暂停合并高血压男性的心脏结构变化及正压通气的治疗作用[J]. 浙江临床医学, 2014,16(8):1213-1214.
[8] 肖永龙,张德平,郑培德.经鼻持续气道正压通气对阻塞性睡眠呼吸暂停低通气综合征患者睡眠结构近远期的影响阴[J].中华内科杂志,2004,43(9):651-653.
[9] 史可云, 谢 婧, 蒋建中,等. 持续气道正压通气对阻塞性睡眠呼吸暂停低通气综合征合并高血压患者外周血淋巴细胞DNA的影响[J].江苏大学学报(医学版), 2014, 10(5):72-74.
[10] 李 霞.阻塞性睡眠呼吸暂停低通气综合征合并高血压患者持续气道正压通气治疗前后血浆ET-1、NPY水平的变化及意义[D].太原:山西医科大学, 2011:26.
[11] Stauffer J L.Echocardiographic and electrocardiographic finding in asymtomatic snoring men[J].Am Rev Resp Dis,1989:139.
[12] Sajkov D.Pulmonary hypenension and hypoxemia in obstructive sleep apneasyndrome[J]. Am J Res Care Med,1994,149:416-422.
[13] Ayas N T,Patel S, Malhotra A,et al.Auto-titrating versus standard continuous positive airway pressure for the treatment of obstructive sleep apnea:results of a meta-analysis[J].Sleep,2004,27(2):249-253.
[14] Barbe F,Duran Cantolla J,Capote F,et al.Long-term effect of continuous positive airway pressure in hypertenSive patients with sleep apnea[J].Am J Respir Crit Care Med,2010,181(7):718-726.
[15] Niroumand M,Kuperstein R,Sasson Z,et al.Impact of obstructive sleep apnea on left ventricular mass and diastolic function[J].Am J Respir Crit Care Med,2001,163(7):1632-1636.
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