阻塞性睡眠呼吸暂停低通气综合征合并高血压性脑出血患者血浆内皮素1和同型半胱氨酸水平及其对认知功能的影响研究

发布时间：2018-06-11 22:33

本文选题：睡眠呼吸暂停 + 阻塞性　；参考：《中国全科医学》2017年21期

【摘要】：目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并高血压性脑出血患者血浆内皮素1(ET-1)和同型半胱氨酸(Hcy)水平变化及其对患者认知功能的影响,为临床上OSAHS合并高血压性脑出血患者认知功能障碍的早期预测提供依据。方法选取华北理工大学附属医院2012年12月—2014年5月收治的符合纳入标准的OSAHS合并高血压性脑出血患者77例(病例组)和单纯高血压性脑出血患者83例(对照组),将病例组分为合并中、重度OSAHS的高血压性脑出血患者49例,合并轻度OSAHS的高血压性脑出血患者28例。患者均进行多导睡眠图监测,记录睡眠呼吸紊乱指数(AHI)、夜间最低血氧饱和度(LSaO_2)。采用简易智能精神状态检查量表(MMSE)和洛文斯顿作业疗法认知评定成套测验(LOTCA)测评两组患者的认知功能。应用放射免疫法和循环酶法分别检测血浆内皮素-1(ET-1)、同型半胱氨酸(Hcy)水平。结果病例组血浆ET-1、Hcy水平高于对照组(P0.05)。合并中、重度OSAHS的高血压性脑出血患者血浆ET-1、Hcy水平高于合并轻度OSAHS的高血压性脑出血患者(P0.05)。病例组患者血浆ET-1、Hcy水平与AHI呈正相关(P0.01);病例组患者血浆ET-1、Hcy水平与LSaO_2呈负相关(P0.01)。与对照组比较,病例组MMSE总分、LOTCA总分及视知觉、空间知觉、运动运用、视运动组织、逻辑思维维度得分均降低(P0.05)。与合并轻度OSAHS的高血压性脑出血患者比较,合并中、重度OSAHS的高血压性脑出血患者MMSE总分、LOTCA总分及定向、视知觉、空间知觉、运动运用、视运动组织、逻辑思维维度得分均降低(P0.05)。病例组血浆ET-1、Hcy水平与MMSE总分、LOTCA总分及其各维度得分均呈负相关(P0.01)。结论OSAHS合并高血压性脑出血患者血浆ET-1、Hcy水平升高,与患者认知功能受损有关。血浆ET-1、Hcy水平可在一定程度上反映OSAHS合并高血压性脑出血患者认知功能障碍的情况。
[Abstract]:Objective to investigate the changes of plasma endothelin 1 (et 1) and homocysteine (Hcy) levels in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) complicated with hypertensive intracerebral hemorrhage and their effects on cognitive function. To provide evidence for early prediction of cognitive dysfunction in patients with OSAHS complicated with hypertensive intracerebral hemorrhage. Methods from December 2012 to May 2014, 77 OSAHS patients with hypertensive intracerebral hemorrhage and 83 patients with simple hypertensive intracerebral hemorrhage (control group) were selected from affiliated Hospital of North China University of Technology. To divide the case into a combination, There were 49 hypertensive intracerebral hemorrhage patients with severe OSAHS and 28 hypertensive intracerebral hemorrhage patients with mild OSAHS. All patients were monitored with polysomnography, sleep apnea index (AHI) and nocturnal lowest oxygen saturation (LSAO _ 2) were recorded. The cognitive function of the two groups was evaluated by MMSE and LOTCAA. Plasma endothelin-1 (et-1) and homocysteine (Hcy) levels were measured by radioimmunoassay and circulating enzyme method respectively. Results the plasma et-1 Hcy level in the case group was higher than that in the control group (P 0. 05). The plasma ET-1 Hcy level in patients with severe OSAHS was higher than that in patients with mild OSAHS (P 0.05). There was a positive correlation between plasma ET-1Hcy level and AHI in the case group and a negative correlation between the plasma ET-1Hcy level and the LSaO2 level in the case group. Compared with the control group, the total score of LOTCA and the scores of visual perception, spatial perception, motor use, visual motor organization and logical thinking dimension of MMSE in the case group were significantly lower than those in the control group (P 0.05). Compared with hypertensive intracerebral hemorrhage patients with mild OSAHS, patients with moderate and severe OSAHS had MMSE total score and LOTCA total score, visual perception, spatial perception, motor use and visual motor tissue. The scores of logical thinking dimension were all decreased (P 0.05). There was a negative correlation between the plasma ET-1 Hcy level and the total score of MMSE and the score of LOTCA and its dimensions (P 0.01). Conclusion the elevated plasma et-1 Hcy level in patients with OSAHS complicated with hypertensive intracerebral hemorrhage is associated with cognitive impairment. Plasma et-1 Hcy level can reflect cognitive dysfunction in patients with OSAHS complicated with hypertensive intracerebral hemorrhage to some extent.
【作者单位】：华北理工大学附属医院;
【基金】：河北省教育厅重点课题(ZD2012046)
【分类号】：R743.34;R766

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