2019 年第 6 期 第 14 卷

原发性高血压合并阻塞性睡眠呼吸暂停低通气综合征患者升主动脉内径的变化及其相关因素分析

Related factors of ascending aorta diameter in patients with hypertension complicated with obstructive sleep apnea hypopnea syndrome

作者：屈丰雪曾荣于静程文立王佐广

英文作者：

单位：100029首都医科大学附属北京安贞医院高血压科（屈丰雪、曾荣、于静、程文立）；100029北京市心肺血管疾病研究所高血压研究室（王佐广）

英文单位：

关键词：原发性高血压；阻塞性睡眠呼吸暂停低通气综合征；呼吸暂停低通气指数；升主动脉内径；动态血压

英文关键词：

• 摘要：

• 【摘要】目的    探讨原发性高血压（EH）合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者升主动脉内径的变化及其相关因素。方法    选取2017年1—12月在首都医科大学附属北京安贞医院高血压科住院的EH患者236例，根据多导睡眠监测呼吸暂停低通气指数(AHI)分为对照组（AHI<5次/min）57例、轻度OSAHS组（AHI 5~15次/min）57例、中度OSAHS组（AHI 16~30次/h）61例、重度OSAHS组（AHI>30次/min）61例。比较4组患者升主动脉内径、动态血压指标、空腹血糖、三酰甘油、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、血尿素氮和血肌酐水平的差异，采用多元逐步回归分析法分析升主动脉内径的影响因素。结果    轻、中、重度OSAHS组升主动脉内径大于对照组［（34.3±0.5）、（34.4±0.4）、（35.2±0.5）mm比(32.0±0.5)mm］(均P＜0.05)，轻、中、重度组升主动脉内径逐渐增宽,但差异无统计学意义（均P>0.05）。重度组24 h心率和白天心率均高于其他3组，中度组和重度组24 h舒张压、白天舒张压均高于对照组，重度组夜间舒张压高于对照组、夜间心率高于中度组，差异均有统计学意义（均P＜0.05）。以升主动脉内径为因变量，以所有变量为自变量进行逐步回归分析结果表明，升主动脉内径与年龄、腹围、夜间舒张压、夜间心率及AHI呈正相关，与总胆固醇呈负相关。回归方程：Y=18.469+0.083×年龄+0.086×腹围+0.078×夜间舒张压+0.081×夜间心率+0.027×AHI-1.023×总胆固醇。结论    EN伴OSAHS患者升主动脉内径增宽，同时升主动脉内径与舒张压、AHI、心率、年龄、腹围等密切相关，这些因素容易导致大血管病变的发生。

• 【Abstract】Objective    To analyze the related factors of ascending aorta diameter in patients with essential hypertension（EH） complicated with obstructive sleep apnea hypopnea syndrom(OSAHS). MethodFrom January to December 2017, 236 EH patients were enrolled in Beijing Anzhen Hospital, Capital Medical University. According to the apnea hypopnea index(AHI) monitored by polysomnography, the patients were divided into control group(AHI<5 times/min, 57 cases), mild OSAHS group(AHI 5-15 times/min, 57 cases), moderate OSAHS group(AHI 16-30 times/min, 61 cases) and severe OSAHS group(AHI>30 times/min, 61 cases). Ascending aorta diameter, ambulatory blood pressure, fasting blood glucose, triglyceride, high density lipoprotein cholesterol(HDL-C), low density lipoprotein cholesterol(LDL-C), blood urea nitrogen and serum creatinine were detected. Influence factors of ascending aorta diameter were analyzed by multiple stepwise regression. Results    Diameter of ascending aorta in mild, moderate and severe OSAHS groups was significantly less than that in control group［（34.3±0.5）, （34.4±0.4）, （35.2±0.5）mm vs (32.0±0.5)mm］(all P<0.05) and the diameter widened among mild, moderate and severe OSAHS groups(P>0.05). The 24 h heart rate and daytime heart rate in severe OSAHS group were higher than those in other groups; 24 h diastolic blood pressure and daytime diastolic blood pressure in moderate and severe OSAHS groups were higher than those in control group; nocturnal diastolic blood pressure in severe group was higher than that in control group; nocturnal heart rate in severe group was higher than that in moderate group（all P＜0.05）. Stepwise regression analysis showed that ascending aorta diameter was positively correlated with age, abdominal circumference, nocturnal diastolic blood pressure, nocturnal heart rate, AHI and it was negatively correlated with total cholesterol level; regression equation: Y=18.469+0.083×age+0.086×abdominal circumference+0.078×nocturnal diastolic blood pressure+0.081×nocturnal heart rate+0.027×AHI-1.023×total cholesterol. Conclusion    EN with OSAHS patients have broadened diameter of ascending aorta; the diameter of ascending aorta is closely related with diastolic blood pressure, AHI, heart rate, age and abdominal circumference; these factors can result in macrovasular diseases.