OSAHS患者上气道阻塞定位及PGP9.5、NCAM在软腭组织中的表达

发布时间：2018-06-30 10:13

本文选题：阻塞性睡眠呼吸暂停低通气综合征 + 软腭　；参考：《安徽医科大学》2014年硕士论文

【摘要】：目的研究阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea/hypopneasyndrome，OSAHS）患者上气道阻塞的部位，研究阻塞部位除了解剖学因素参与OSAHS的发生，是否还存在神经肌肉调节的异常参与了OSAHS的发生。方法1.选择经我院PSG(Polysomnography，多导睡眠监测)诊断的100例OSAHS患者行常规的体格检查，例如身高、体重、颈围、是否有颌面结构异常，专科检查，例如鼻咽、口咽、喉咽等处是否有解剖学上的阻塞，纤维鼻咽喉镜检查结合Muller实验，上气道CT扫描范围为环状软骨到鼻咽顶等明确患者上气道易发生阻塞的部位。2.选择30例经我院PSG检查诊断为OSAHS的患者作为实验组，10例经PSG检查排除OSAHS的单纯慢性扁桃体炎患者作为对照组。通过HE染色检测实验组和对照组软腭组织中末梢神经的分布，通过免疫组化检测实验组和对照组软腭组织中蛋白基因产物9.5（protein gene product9.5，PGP9.5）、神经细胞黏附因子（neural cell adhesion molecule，NCAM）的表达，PGP9.5、NCAM的表达水平采用累积光密度（integrated optical density，IOD）进行半定量测定。比较实验组和对照组中PGP9.5及NCAM的IOD的差异及对照组中PGP9.5及NCAM表达水平与AHI的关系。结果1.常规专科检查：鼻腔结构较正常狭窄者共80例，以鼻中隔偏曲及慢性肥厚性鼻炎较常见。根据Friedman分级，见腭舌关系2°共13例，腭舌关系3°共36例，，腭舌关系4°共51例。纤维鼻咽喉镜检查结合Muller实验：鼻咽部狭窄的共80例，口咽部狭窄中腭后区气道狭窄的共98例，单纯腭后区气道狭窄的共32例，腭后区狭窄合并舌后区狭窄66例，单纯舌后区狭窄2例。上气道CT扫描检查：鼻咽部狭窄81例，口咽部狭窄中98例腭后区气道狭窄，33例单纯腭后区气道狭窄，65例腭后区狭窄合并舌后区狭窄，单纯舌后区狭窄2例。2.（1）实验组软腭不同层次组织中末梢神经的分布不同，末梢神经主要分布在黏膜下层、腺体、血管周围，肌肉组织周围少量分布；（2）实验组OSAHS患者软腭组织中PGP9.5及NCAM表达水平明显高于对照组，差异具有统计学意义（P0.05）；（3）PGP9.5和NCAM的表达水平与呼吸暂停低通气指数（AHI）呈正相关（分别为r=0.706，P=0.01；r=0.636，P=0.01）。结论（1）OSAHS患者最易发生阻塞的部位为软腭后区，舌后区平面阻塞也占重要比例， OSAHS患者软腭具有解剖学上的狭窄；（2）常规专科检查、纤维鼻咽喉镜检查、上气道CT检查结合能更好的确定OSAHS患者上气道的阻塞部位；（3）OSAHS患者和非OSAHS者软腭组织中同样存在末梢神经及神经反射；（4）OSAHS患者软腭组织中末梢神经的分布及神经肌肉支配存在异常，且与病情严重程度密切相关。
[Abstract]:Objective to study the location of upper airway obstruction in patients with obstructive sleep apnea hypopnea syndrome (obstructive sleep apnea / hypopnea syndrome). Method 1. A total of 100 OSAHS patients diagnosed by PSG (polysomnography) were selected for routine physical examination, such as height, weight, neck circumference, abnormal maxillofacial structure, and specialized examinations, such as nasopharynx, oropharynx, etc. If there is anatomic obstruction in laryngopharynx, fiberoptic rhinolaryngoscopy combined with Muller's experiment, the CT scan range of upper airway is from annular cartilage to nasopharynx top. Thirty patients with OSAHS diagnosed by PSG in our hospital were selected as experimental group and 10 patients with simple chronic tonsillitis who were excluded from OSAHS by PSG examination as control group. The distribution of peripheral nerves in soft palate tissue of experimental group and control group was detected by HE staining. The expression of protein gene product 9.5 (protein gene product 9.5 and nerve cell adhesion factor (neural cell adhesion 9.5 in soft palate tissue of experimental group and control group were detected by immunohistochemistry. The expression level of PGP9.5NCAM in soft palate tissue was measured by (integrated optical density (integrated optical). The difference of IOD in PGP 9.5 and NCAM between experimental group and control group and the relationship between PGP 9.5 and NCAM expression level and AHI in control group were compared. Result 1. Routine examination showed that 80 patients with normal nasal stenosis were found to have nasal septum deviation and chronic hypertrophic rhinitis. According to Friedman's classification, there were 13 cases of palatoglossal relation (2 掳), 36 cases of palatoglossal relation (3 掳) and 51 cases of palatoglossal relationship (4 掳). The results were as follows: 80 cases of nasopharynx stenosis, 98 cases of posterior palatine airway stenosis, 32 cases of simple posterior palatine airway stenosis, 66 cases of posterior palatal area stenosis. There were 2 cases of simple posterior lingual stenosis. Ct scan of upper airway: nasopharynx stenosis in 81 cases, oropharyngeal stenosis in 98 cases, posterior palatine area airway stenosis in 33 cases, simple posterior palatine area airway stenosis in 65 cases, posterior palatine area stenosis with posterior lingual area stenosis in 65 cases. (1) the distribution of peripheral nerves in different layers of soft palate in the experimental group was different. The peripheral nerves were mainly distributed in the submucosa, glands, blood vessels, and a small amount of muscle tissue. (2) the expression levels of PGP9.5 and NCAM in soft palate of OSAHS patients in the experimental group were significantly higher than those in the control group (P0.05). The expression levels of PGP9.5 and NCAM were positively correlated with apnea hypopnea index (AHI) (P < 0.05). Conclusion (1) the most likely site of obstruction in OSAHS patients is the posterior soft palate, the posterior lingual area is also an important part, the soft palate has anatomic stricture in OSAHS patients, (2) routine specialized examination, fiberoptic rhinolaryngoscopy examination, Ct examination of upper airway can better determine the location of obstruction of upper airway in OSAHS patients. (3) peripheral nerve and nerve reflex are also present in soft palate tissues of OSAHS patients and non-OSAHS patients. (4) the distribution and neuromuscular innervation of peripheral nerves in soft palate tissue of OSAHS patients were abnormal, and were closely related to the severity of the disease.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R766

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