OSAHS合并高血压患者脉搏波速度改变及其影响因素
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Changes and impact factors of pulse wave velocity in patients with obstructive sleep apnea hypopnea syndrome and hypertension
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    目的:探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并高血压患者颈-股脉搏波速度(c-fPWV)和颈-桡脉搏波速度(c-rPWV)的改变及影响因素。方法:选择行PSG监测者160例,正常对照组-OSAHS组-高血压组-OSAHS合并高血压组各40例,所有研究对象应用脉搏波速度(PWV)自动测量系统测定c-fPWV及c-rPWV,分别作为反映中央弹性大动脉和外周中等肌性动脉弹性功能的指标。分析影响脉搏波速度的相关指标。结果:与正常对照组相比,HT组-OSAHS组-OSAHS+HT组c-fPWV明显升高,差异具有统计学意义(F = 23.056,P < 0.05),且OSAHS+HT组高于HT组(P < 0.01);HT组-OSAHS+HT组c-rPWV与对照组比较显著增高,差异有统计学意义(P均< 0.01)。简单分析-偏相关分析都显示c-fPWV与c-rPWV之间显著相关(P均< 0.01)。多元线性逐步回归显示,c-fPWV与年龄-收缩压-心率呈正相关,与女性呈负相关(R2 = 0.537,P = 0.000);c-rPWV与舒张压呈正相关(R2 = 0.052,P = 0.041)。结论:随着OSAHS病情加重,c-fPWV增高,OSAHS合并高血压存在更明显的动脉硬度增加。c-fPWV与性别-年龄-心率-收缩压等具有相关性,c-rPWV与舒张压有相关性。PWV可作为OSAHS患者血管早期病变检测及评估的功能指标,大动脉弹性功能检测具有重要的临床意义。

    Abstract:

    Objective:To analyze the changes of carotid-femoral and carotid-radial pulse wave velocity in patients with obstructive sleep apnea hypopnea syndrome (OSAHS)associated with hypertension,and effect factors on these changes. Methods:One hundred and sixty research objects were classified into four groups according to the hypertension history and polysomnography(PSG):control group (40 patients),hypertension group (40 patients),OSAHS group (40 patients),and OSAHS with hypertension group (40 patients). Automatic pulse wave velocity measuring system was applied to examine carotid-femoral pulse wave velocity(c-fPWV) and carotid-radial pulse wave velocity(c-rPWV) as the parameters reflecting central elastic large arterial and peripheral muscular medium-sized arterial elasticity respectively. Results:Compared to control group,hypertension,OSAHS,and OSAHS with hypertension groups had significantly higher c-fPWV(F = 23.056,P < 0.05),and OSAHS with hypertension group had significantly higher c-fPWV than hypertension group[(10.72 ± 1.06)m/s]vs[(10.09 ± 1.05)m/s,P < 0.01]. Compared to control group,hypertension,OSAHS with hypertension group had significantly higher c-rPWV(P < 0.01). C-fPWV correlated significantly with c-rPWV (all P < 0.01) by both Pearson and partial correlation analysis adjusted by age,body mass index,waist-hip ratio,systolic blood pressure,diastolic blood pressure and heart rate. Multiple stepwise regression analysis showed that the age,systolic blood pressure and heart rate were positively while female gender was negatively correlated with c-fPWV (R2 = 0.537,P = 0.000). C-rPWV was positively correlated with diastolic blood pressure(R2 = 0.052,P= 0.041).Conclusion:Our study showed that arterial stiffness was increased in OSAHS patients,and with OSAHS exacerbations,c-fPWV value increased. Arterial stiffness was more severe in the patients with OSAHS and hypertension. The change of c-fPWV of patients with OSAHS was related to age,female gender,systolic blood pressure and heart rate. C-rPWV was associated with diastolic pressure. The PWV would be an applicable functional index in early diagnosis of vascular pathological changes and in medical evaluation . Examining the change of large arterial elasticity has important clinical value in OSAHS patients.

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白金梅,姜秀峰,惠复新,崔小川. OSAHS合并高血压患者脉搏波速度改变及其影响因素[J].南京医科大学学报(自然科学版),2013,(3):372-377

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  • 收稿日期:2012-11-27
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  • 在线发布日期: 2013-06-04
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