OSAS患者阻塞性睡眠呼吸暂停严重程度与血管内皮功能改变相关研究

Study of the Correlations between Vascular Endothelial Function in Patients with Obstructive Sleep Apnea Hypopnea Syndrome

摘要: 目的：探究阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome, OSAS)患者呼吸紊乱指数与血管内皮功能变化的关系。方法：招募通过睡眠脑电图测定诊断为阻塞性睡眠呼吸暂停低通气综合征的22例打鼾患者为实验组及17例睡眠正常者作为对照组进行相关研究，获得研究对象的年龄、BMI、血压、颈围、腹围等基本资料，利用血管内皮检测仪测定肱动脉基础内径(D0)、反应性充血后肱动脉内径(D1)和服用硝酸甘油后肱动脉内径(D2)。根据公式：血流介导的血管扩张比(flow mediated dilatation, FMD) = [(D1 − D0)/D0] × 100%，硝酸甘油介导的血管扩张比(nitroglycerin induced dilatation, NID) = [(D2 − D0)/D0] × 100%分别计算血流介导的和口服硝酸甘油介导的血管内径扩张比，与对照组进行比较，探讨影响该血管直径变化率的主要因素。结果：对试验组和对照组的超声检查结果进行对比，两组在肱动脉基础内径和反应性充血后肱动脉内径上差异没有统计学意义(P > 0.05)；而在反应性充血后内径变化率和服用硝酸甘油后肱动脉内径、服用硝酸甘油后内径变化率等方面差异有统计学意义(P < 0.05)。对两组间的AHI和血管内皮细胞功能指标结果进行比较，结果显示差异有统计学意义(P < 0.05)。同时，将内皮细胞功能与AHI做相关研究，结果显示：AHI与内皮功能存在相关性，且AHI越高，FMD和NID的值越低。结论阻塞性睡眠呼吸暂停低通气综合征患者存在血管内皮功能性病变，且随着AHI指数的增高，血管内皮功能受损程度越严重。

Abstract: Objective: To investigate the correlation between polysomnography and vascular endothelial func-tion in patients with OSAS. Methods: 22 patients with obstructive sleep apnea hypopnea syndrome diagnosed by sleep electroencephalogram were selected as experimental group and 17 patients with normal sleep as control group. Obtain the study subjects’ basic information such as age, BMI, blood pressure, neck circumference, and abdominal circumference, use the vascular endothelial detector to measure the basal diameter (D0) of brachial artery, the brachial artery diameter (D1) after reactive congestion and the brachial artery diameter (D2) after nitroglycerin administration. According to the formula FMD = [(D1 − D0)/D0] × 100%, NID = [(D2 − D0)/D0] × 100%, the ratio of blood flow-mediated and oral nitroglycerin-mediated vasodilation was calculated respectively. The main factors affecting the rate of vasodilation were compared with the control group, and the pathological changes of vascular endothelial function in patients with obstructive sleep ap-nea-hypopnea syndrome were evaluated. Results: There was no significant difference in the basal diameter of the right brachial artery and the internal diameter of the brachial artery after reactive congestion between the experimental group and the control group (P > 0.05), but there were signif-icant differences in the change rate of the internal diameter of the brachial artery after reactive congestion, the change rate of the internal diameter of the brachial artery after taking nitroglycerin and the change rate of the internal diameter after taking nitroglycerin (P < 0.05). Analyzing the re-sults of AHI and vascular endothelial cell function between the two groups, the results showed that there was significant difference (P < 0.05). Meanwhile, the correlation between endothelial cell function and AHI was studied. The results showed that AHI was associated with endothelial function and the higher the AHI, the lower the values of FMD and NID. Conclusion: Patients with obstructive sleep apnea hypopnea syndrome have functional lesions of vascular endothelium. With the increase of AHI index, the degree of vascular endothelial function damage was more serious.