阻塞性睡眠呼吸暂停低通气综合征患者咽部触觉阈与黏膜组织病理形态学的研究
发布时间：2018-08-22 18:30
【摘要】：目的:阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)是临床上常见的疾病,其发病机制复杂,研究显示上气道周围神经病变是OSAHS的发病原因之一,但机制尚不明确。本课题通过测试OSAHS患者和正常对照组的软腭黏膜触觉阈,以及通过对OSAHS患者和扁桃体良性病变患者的软腭黏膜组织进行病理形态学研究,并进行比较,以反映OSAHS患者咽部感觉的损伤性病变,为进一步探讨上气道周围神经病变在OSAHS发生及发展中的作用提供依据。方法:1、第一部分以第二军医大学附属长海医院耳鼻咽喉头颈外科2015年8月至2016年2月经PSG检查确诊的33例不同程度OSAHS患者作为OSAHS组,招募的经PSG检查排除OSAHS的正常志愿者33例作为正常对照组,对所有研究对象手、颊黏膜以及软腭黏膜的触觉阈进行测量,并进行两组间比较,采用Mann-Whitney U检验分析两组间的差异有无统计学意义,同时分析OSAHS组软腭黏膜的触觉阈与AHI的相关性。2、第二部分也以第二军医大学附属长海医院耳鼻咽喉头颈外科2015年6月至2016年2月经PSG检查确诊的OSAHS患者作为OSAHS组,共18例。扁桃体良性病变患者作为对照组,共17例。手术过程中收集所有研究对象的软腭黏膜组织标本,石蜡切片后进行HE染色和Masson三色染色,光镜下观察OSAHS组软腭黏膜组织的病理形态学改变,图像分析系统对两组软腭黏膜组织的胶原纤维相对截面积、炎性细胞数量进行分析,采用t检验分析两组间的差异有无统计学意义。结果:1、第一部分研究结果显示:OSAHS组与正常对照组手背部皮肤的触觉阈比较,经Mann-Whitney U检验,统计量u=468.500,双侧检验P=0.323,差异无统计学意义(P0.05);OSAHS组与正常对照组颊黏膜的触觉阈比较,经Mann-Whitney U检验,统计量u=423.500,双侧检验P=0.113,差异也无统计学意义(P0.05);而OSAHS组与对照组软腭黏膜的触觉阈比较,经Mann-Whitney U检验,统计量u=333.500,双侧检验P=0.007,差异有统计学意义(P0.01)。OSAHS组软腭腹侧黏膜触觉阈与AHI相关性分析显示样本等级相关系数r_s=0.322,双侧检验P=0.068,相关性无统计学意义(P0.05)。2、第二部分研究结果显示:与对照组相比,OSAHS组软腭黏膜的黏膜层鳞状上皮细胞明显肿胀,形态不规则,固有层明显增厚,黏膜下疏松结缔组织中可见大量炎性细胞浸润,胶原纤维增生,脂肪空泡增多18/18(100%)。OSAHS组和对照组软腭黏膜组织胶原纤维相对截面积的比较,差异有统计学意义(t=7.762,P0.001);OSAHS组和对照组软腭黏膜组织炎性细胞数量的比较,差异有统计学意义(t=159.829,P0.001)。结论:OSAHS患者与正常对照组相比,软腭黏膜的触觉阈明显升高,触觉功能下降,与扁桃体良性病变患者相比,OSAHS患者软腭黏膜出现水肿、大量炎性细胞浸润以及胶原纤维组织明显增生等改变,反映出OSAHS患者存在咽部感觉的损伤,并有其组织病理学的依据,提示上气道周围神经病变与OSAHS发生及发展有关。
[Abstract]:OBJECTIVE: Obstructive sleep apnea hypopnea syndrome (OSAHS) is a common disease in clinic. The pathogenesis of OSAHS is complex. Studies have shown that upper airway peripheral neuropathy is one of the causes of OSAHS, but the mechanism is still unclear. The palatal tactile threshold and the soft palatal mucosa of OSAHS patients and benign tonsillar lesions were studied and compared in order to reflect the pharyngeal sensory impairment of OSAHS patients. Methods: 1. Thirty-three patients with OSAHS diagnosed by PSG from August 2015 to February 2016 in the Otolaryngology Head and Neck Surgery Department of Changhai Hospital Affiliated to the Second Military Medical University were selected as the OSAHS group. Thirty-three normal volunteers excluding OSAHS by PSG were recruited as the normal control group. Mann-Whitney U test was used to analyze the difference between the two groups. Meanwhile, the correlation between tactile threshold of soft palate mucosa and AHI in OSAHS group was analyzed. 2. The second part was also diagnosed by PSG in the Department of Otolaryngology Head and Neck Surgery, Changhai Hospital Affiliated to the Second Military Medical University from June 2015 to February 2016. Patients with OSAHS were divided into OSAHS group (18 cases) and benign tonsillar lesions (17 cases) as control group (17 cases). Relative cross-sectional area of collagen fibers and the number of inflammatory cells in soft palate mucosa were analyzed. There was no significant difference between the two groups by t-test. Results: 1. The results of the first part of the study showed that the tactile threshold of the back skin of the hand in OSAHS group was compared with that of the normal control group. The statistical value u was 468.500 by Mann-Whitney U test, and the bilateral test P was 0.3. There was no significant difference between the OSAHS group and the normal control group (P 0.05). After Mann-Whitney U test, the statistical value u = 423.500 and the bilateral test P = 0.113, there was no significant difference between the OSAHS group and the control group (P 0.05). However, compared with the soft palate mucosa, the OSAHS group and the control group, the statistical value u = 333.500 and the bilateral test P = 0.113, there was no significant difference (P 0.05). There was no significant difference between OSAHS group and control group (P 0.01). The correlation analysis between OSAHS group and AHI showed that the correlation coefficient of sample rank r_s = 0.322, and bilateral test P = 0.068. The correlation was not statistically significant (P 0.05). The second part of the study showed that the soft palate mucosal squamous epithelial cells in OSAHS group were significantly swollen compared with the control group. There were a lot of inflammatory cells infiltration, collagen fiber proliferation and fat vacuole increase in 18/18 (100%) in loose connective tissue of submucosa. The relative cross-sectional area of collagen fibers in soft palate mucosa of OSAHS group and control group was significantly different (t = 7.762, P 0.001). The number of inflammatory cells in the soft palate of OSAHS patients was significantly higher than that of the normal control group (t = 159.829, P 0.001). Obvious tissue hyperplasia and other changes reflect the presence of pharyngeal sensory impairment in OSAHS patients, and have its histopathological basis, suggesting that upper airway peripheral neuropathy is related to the occurrence and development of OSAHS.
【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R766
[Abstract]:OBJECTIVE: Obstructive sleep apnea hypopnea syndrome (OSAHS) is a common disease in clinic. The pathogenesis of OSAHS is complex. Studies have shown that upper airway peripheral neuropathy is one of the causes of OSAHS, but the mechanism is still unclear. The palatal tactile threshold and the soft palatal mucosa of OSAHS patients and benign tonsillar lesions were studied and compared in order to reflect the pharyngeal sensory impairment of OSAHS patients. Methods: 1. Thirty-three patients with OSAHS diagnosed by PSG from August 2015 to February 2016 in the Otolaryngology Head and Neck Surgery Department of Changhai Hospital Affiliated to the Second Military Medical University were selected as the OSAHS group. Thirty-three normal volunteers excluding OSAHS by PSG were recruited as the normal control group. Mann-Whitney U test was used to analyze the difference between the two groups. Meanwhile, the correlation between tactile threshold of soft palate mucosa and AHI in OSAHS group was analyzed. 2. The second part was also diagnosed by PSG in the Department of Otolaryngology Head and Neck Surgery, Changhai Hospital Affiliated to the Second Military Medical University from June 2015 to February 2016. Patients with OSAHS were divided into OSAHS group (18 cases) and benign tonsillar lesions (17 cases) as control group (17 cases). Relative cross-sectional area of collagen fibers and the number of inflammatory cells in soft palate mucosa were analyzed. There was no significant difference between the two groups by t-test. Results: 1. The results of the first part of the study showed that the tactile threshold of the back skin of the hand in OSAHS group was compared with that of the normal control group. The statistical value u was 468.500 by Mann-Whitney U test, and the bilateral test P was 0.3. There was no significant difference between the OSAHS group and the normal control group (P 0.05). After Mann-Whitney U test, the statistical value u = 423.500 and the bilateral test P = 0.113, there was no significant difference between the OSAHS group and the control group (P 0.05). However, compared with the soft palate mucosa, the OSAHS group and the control group, the statistical value u = 333.500 and the bilateral test P = 0.113, there was no significant difference (P 0.05). There was no significant difference between OSAHS group and control group (P 0.01). The correlation analysis between OSAHS group and AHI showed that the correlation coefficient of sample rank r_s = 0.322, and bilateral test P = 0.068. The correlation was not statistically significant (P 0.05). The second part of the study showed that the soft palate mucosal squamous epithelial cells in OSAHS group were significantly swollen compared with the control group. There were a lot of inflammatory cells infiltration, collagen fiber proliferation and fat vacuole increase in 18/18 (100%) in loose connective tissue of submucosa. The relative cross-sectional area of collagen fibers in soft palate mucosa of OSAHS group and control group was significantly different (t = 7.762, P 0.001). The number of inflammatory cells in the soft palate of OSAHS patients was significantly higher than that of the normal control group (t = 159.829, P 0.001). Obvious tissue hyperplasia and other changes reflect the presence of pharyngeal sensory impairment in OSAHS patients, and have its histopathological basis, suggesting that upper airway peripheral neuropathy is related to the occurrence and development of OSAHS.
【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R766
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