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目的研究并发中重度阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)的老年高血压患者血压的变化情况及炎症因子的水平,从而揭示此类患者的疾病特点。方法将60例年龄大于60岁的研究对象根据诊所血压、24 h动态血压和多导睡眠图监测结果分为单纯高血压病组(n=30)和并发OSAS组(高血压病并发中重度睡眠呼吸暂停综合征,n=30)。用ELISA法测定白介素-6(IL-6)、sCD40L、超敏C反应蛋白(hs-CRP)、可溶性细胞间黏附分子1(ICAM-1)及血管细胞黏附分子1(VCAM-1)的浓度。结果①并发OSAS组中非杓型血压的发生率为67%,明显高于单纯高血压组的发生率37%(P<0.05)。②并发OSAS组24 h、白天、夜间平均脉压(mean arterial blood pressure,MAP)分别为(51±13)mmHg(1 mmHg=0.133 kPa),(50±13)mmHg和(51±17)mmHg均明显高于单纯高血压组(45±7)mmHg,(46±8)mmHg和(44±6)mmHg,并有统计学意义(P<0.05)。③并发OSAS组的IL-6、sCD40L、hs-CRP、ICAM-1、VCAM-1浓度明显高于单纯高血压组。④并发OSAS组的hs-CRP、ICAM-1、VCAM-1浓度变化与呼吸紊乱指数、睡眠血氧下降程度正相关(r=0.852,P<0.05)。hs-CRP与MAP呈正相关(P<0.01),ICAM-1与夜间血压下降率呈负相关(P<0.05)。结论中重度睡眠呼吸暂停影响老年人血压昼夜节律的变化,同时对脉压产生明显影响,炎症反应也明显加重。
Objective To study the changes of blood pressure and the level of inflammatory cytokines in elderly hypertensive patients complicated with moderate and severe obstructive sleep apnea syndrome (OSAS), so as to reveal the disease characteristics of these patients. Methods Sixty patients aged above 60 years old were divided into simple hypertension group (n = 30) and concurrent OSAS group (hypertension complicated with moderate to severe sleepiness) according to clinic blood pressure, 24-hour ambulatory blood pressure and polysomnography. Apnea syndrome, n = 30). The concentrations of interleukin-6, sCD40L, hs-CRP, ICAM-1 and VCAM-1 were determined by ELISA. . Results ① The incidence of non-dipper blood pressure in concurrent OSAS group was 67%, which was significantly higher than that in simple hypertension group (37%, P <0.05). ② The mean arterial blood pressure (MAP) of patients with OSAS at 24 h were (51 ± 13) mmHg (1 mmHg = 0.133 kPa), (50 ± 13) mmHg and (51 ± 17) mmHg (45 ± 7) mmHg, (46 ± 8) mmHg and (44 ± 6) mmHg, respectively, with statistical significance (P <0.05). ③ The concentrations of IL-6, sCD40L, hs-CRP, ICAM-1 and VCAM-1 in OSAS group were significantly higher than those in simple hypertension group. ④ The changes of hs-CRP, ICAM-1 and VCAM-1 levels in OSAS group were positively correlated with the index of respiratory disorder and the decline of sleep oxygen (r = 0.852, P <0.05). There was a positive correlation between hs-CRP and MAP (P <0.01), and a negative correlation between ICAM-1 and nocturnal blood pressure (P <0.05). Conclusions Moderate and severe sleep apnea affects the changes of circadian rhythm of blood pressure in the elderly, and at the same time exerts a significant effect on the pulse pressure, and the inflammatory response also aggravates.