氧化低密度脂蛋白、总抗氧化能力与OSAHS及OSAHS合并高血压的相关性研究

发布时间：2018-06-01 09:26

  本文选题：阻塞性睡眠呼吸暂停低通气综合征(OSAHS) + 高血压病(HT)　； 参考：《河北医科大学》2010年硕士论文

【摘要】： 目的：通过检测阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome, OSAHS)及阻塞性睡眠呼吸暂停低通气综合征合并高血压(obstructive sleep apnea-hypopnea syndrome associated hypertension,OSAHS+HT)患者血清氧化低密度脂蛋白(oxidized low density lipoprotein,OX-LDL)、总抗氧化能力(total-antoxidant capability, T-AOC)水平的变化,研究两者与OSAHS及OSAHS+HT的相关性,旨在探讨OSAHS及OSAHS+HT患者体内氧化损伤及抗氧化情况,以及两者在OSAHS及OSAHS+HT的病因、发病机制及病情进展中的作用。 方法：随机选择OSAHS患者46例(均为男性),均经多导睡眠仪(polysomnography, PSG)监测确诊,OSAHS的诊断依据中华医学会呼吸病学分会睡眠呼吸疾病学组制定的诊断标准,其中单纯OSAHS患者22例,年龄30～55(42.86±7.07)岁,体重指数20.57～34.72(27.68±3.41)kg/m2。OSAHS+HT患者24例,年龄30～56(41.25±7.70)岁,体重指数23.66～35.43(29.12±2.49)kg/m2,符合OSAHS诊断标准,并达到《中国高血压防治指南》高血压诊断标准,高血压发生晚于OSAHS,且排除肾源性、内分泌性等因素引起的继发性高血压；正常对照组24例(均为男性),年龄27～55(40.08±7.47)岁,体重指数22.31～31.8(27.66±2.04)kg/m2,经询问病史及行Stardust便携式睡眠监测仪初筛检查,排除OSAHS。三组间年龄和体重指数无显著性差异(均p0.05),并除外吸烟、饮酒、饮食及药物等干扰因素。所有入选对象均除外各种急慢性感染、肝肾疾病、风湿免疫疾病、脑血管疾病、恶性肿瘤、糖尿病、冠心病等。所有入选者在睡眠呼吸监测结束,晨醒5分钟内抽取空腹肘静脉血4ml,分别采用酶联免疫吸附法测定氧化低密度脂蛋白,比色法测定总抗氧化能力。并记录有关的监测指标,包括睡眠呼吸暂停低通气指数(apnea hypopnea index, AHI)、血氧饱和度(SaO2)90%时间占总睡眠时间百分比、睡眠呼吸障碍事件时最低SaO2及平均最低SaO2、睡眠呼吸障碍事件总时间占总睡眠时间百分比、睡眠呼吸障碍最长时间。比较正常对照组、OSAHS、OSAHS+HT三组间OX-LDL、T-AOC水平,三组间OX-LDL、T-AOC比较采用方差分析,两两比较采用SNK-q检验。OSAHS与OSAHS+HT患者的睡眠呼吸监测指标比较采用t检验,并将OSAHS、OSAHS+HT患者血清OX-LDL、T-AOC水平与睡眠呼吸监测指标进行直线相关分析。 结果： 1.正常对照组、OSAHS组、OSAHS+HT组血清OX-LDL、T-AOC比较。1.1血清OX-LDL水平：正常对照组为7.06±0.49mg/dl, OSAHS组为10.84±1.15mg/dl, OSAHS+HT组为12.79±1.13mg/dl。与正常对照组比较,OSAHS组及OSAHS+HT组OX-LDL浓度均升高,OSAHS+HT与OSAHS比较OX-LDL浓度升高更明显,均有统计学意义(p0.01)。1.2血清T-AOC水平：正常对照组为12.48±1.22U/ml, OSAHS组为10.05±0.7U/ml, OSAHS+HT组为8.56±0.64 U/ml；与正常对照组比较,OSAHS组及OSAHS+HT组T-AOC水平均降低,OSAHS+HT与OSAHS比较T-AOC水平降低更明显,均有统计学意义(p0.05)。 2. OSAHS+HT与OSAHS两组睡眠呼吸监测指标比较：AHI、SaO290%时间占总睡眠时间百分比、睡眠呼吸障碍事件总时间占总睡眠时间百分比升高,均具有统计学差异(t分别为-5.17,-2.91,-4.11；p0.01,p0.05,p0.05)；睡眠呼吸障碍事件时最低SaO2、平均最低血氧饱和度均降低,且差异具有显著性,(t分别为4.37,3.89；p0.05,p0.05)；而睡眠呼吸障碍最长时间在两组间无统计学差异(t=-1.86,p0.05)。 3.血清OX-LDL、T-AOC水平分别与OSAHS及OSAHS+HT患者睡眠呼吸监测各项指标行直线相关分析：血清OX-LDL水平分别与OSAHS组、OSAHS+HT组的AHI、SaO290%时间占总睡眠时间百分比、睡眠呼吸障碍事件总时间占总睡眠时间百分比呈正相关。与睡眠呼吸障碍事件时最低SaO2,平均最低血氧饱和度呈负相关,与睡眠呼吸障碍最长时间无相关性。血清T-AOC水平与OSAHS组、OSAHS+HT组的AHI、SaO290%时间占总睡眠时间百分比、睡眠呼吸障碍事件总时间占总睡眠时间百分比呈负相关。与睡眠呼吸障碍事件时最低SaO2,平均最低血氧饱和度呈正相关,与睡眠呼吸障碍最长时间无相关性。 结论： 1.OSAHS患者无论是否合并高血压,均存在氧化应激及氧化损伤。且OSAHS患者的氧化应激的发生是独立于或先于高血压的发生而发展的。 2.OSAHS+HT患者病情更严重,缺氧更明显。氧化应激可能为OSAHS患者发生高血压的原因之一。 在OSAHS及OSAHS+HT患者体内均存在氧化抗氧化失衡,且这种失衡在OSAHS+HT患者体内更明显。OX-LDL、T-AOC在阻塞性睡眠呼吸暂停低通气综合征患者血中含量的变化可反映病情的严重程度,了解氧化应激的程度,可指导OSAHS的早期治疗及改善其预后。
[Abstract]:Objective: to detect the serum oxidized low density lipoprotein (LDL) in patients with obstructive sleep apnea hypopnea syndrome (obstructive sleep apnea-hypopnea syndrome, OSAHS) and obstructive sleep apnea hypopnea syndrome with hypertension (obstructive sleep apnea-hypopnea syndrome associated hypertension, OSAHS+HT). D low density lipoprotein, OX-LDL), the changes in the total antioxidant capacity (total-antoxidant capability, T-AOC), and the correlation of both OSAHS and OSAHS+HT. The purpose of this study is to explore the oxidative damage and antioxidant status of OSAHS and OSAHS+HT patients, as well as their role in the pathogenesis, pathogenesis and progress of the disease.
Methods: 46 patients (all male) were selected randomly, all of them were diagnosed by polysomnography (PSG). The diagnosis of OSAHS was based on the diagnostic criteria of the sleep respiratory disease group of the Chinese Medical Association of respiratory diseases, including 22 cases of simple OSAHS patients, age 30~55 (42.86 + 7.07) years, and body mass index 20.57 to 34.72 (27.68 +). 3.41) 24 cases of kg/m2.OSAHS+HT patients, age 30~56 (41.25 + 7.70) years, body mass index 23.66 to 35.43 (29.12 + 2.49) kg/m2, conformed to the OSAHS diagnostic criteria, and reached < Chinese Hypertension Prevention Guide > hypertension diagnosis standard, hypertension occurred later than OSAHS, and excluded secondary hypertension caused by renal origin, endocrine and other factors; normal control Group 24 (all male), age 27~55 (40.08 + 7.47) years, body mass index 22.31 ~ 31.8 (27.66 + 2.04) kg/m2, after inquiry of medical history and Stardust portable sleep monitor first screening test, exclude the age and body mass index of OSAHS. three groups of no significant difference (all P0.05), except smoking, drinking, diet and drugs and other interference factors. All selected All the subjects were except for all kinds of acute and chronic infection, liver and kidney disease, rheumatic immune disease, cerebrovascular disease, malignant tumor, diabetes, coronary heart disease, etc. all the participants were selected at the end of the sleep breathing monitoring, the 4ml of the empty abdominal vein blood was extracted within 5 minutes in the morning, and the oxidized low density lipoprotein was measured by enzyme linked immunosorbent assay, and the colorimetric assay was used to determine the total antioxidant activity. Ability. And records related monitoring indicators, including the sleep apnea hypopnea index (apnea hypopnea index, AHI), blood oxygen saturation (SaO2) 90%, the percentage of total sleep time, the lowest SaO2 and the mean lowest SaO2 in the sleep apnea event, the percentage of total sleep time, the percentage of total sleep time, and the sleep apnea. The longest time. Compared with the normal control group, OSAHS, OSAHS+HT three groups, OX-LDL, T-AOC level, three groups of OX-LDL, T-AOC compared with variance analysis, 22 compared with SNK-q test.OSAHS and OSAHS+HT patients' sleep breathing monitoring indexes compared to t test, OSAHS, OSAHS serum levels and sleep breathing monitoring indicators The linear correlation analysis is carried out.
Result锛，

本文编号：1963695