原发性高血压伴阻塞性睡眠呼吸暂停低通气综合征对左心室结构的影响

目的:研究原发性高血压(EH)伴阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与左心室结构改变的关系,并分析其可能的影响因素。方法:随机抽取2007年10月至2010年11月,在北京安贞医院高血压科住院的男性,年龄30～60岁,EH患者282例,进行夜间多导睡眠监测,并对其一般资料、生化指标、超声心动图检查结果进行分析,比较EH+OSAHS与EH患者间左心室结构的差异,观察其影响因素。结果:①EH+OSAHS组体质量指数、空腹及餐后2 h血糖均高于EH组,差异有统计学意义(均P<0.05);EH+OSAHS组血总胆固醇、三酯甘油、低密度脂蛋白、尿酸均高于EH组,EH+OSAHS组计算的肾小球滤过率低于EH组,差异无统计学意义(P>0.05)。②EH+OSAHS组的左心室舒张末期内径、室间隔厚度、左心室后壁厚度、左心室质量指数均高于EH组,差异有统计学意义(均P<0.05);EH+OSAHS组左心室肥厚(LVH)的患病率明显高于EH组(41.0%vs.27.3%)。③Logistic回归分析表明:与左心室肥厚发生相关的危险因素为OSAHS(OR=1.827,95%CI=1.006～3.220,P=0.048)、高血压病程(OR=2.122,95%CI=1.185～3.982,P=0.012)、血压分级(OR=3.797,95%CI=2.447～5.893,P=0.000)。结论:与EH相比,EH+OSAHS左心室构型改变更加严重;其危险因素可能为OS-AHS、高血压病程、血压分级。

The impact of essential hypertension with obstructive sleep apnea hypopnea syndrome on left ventricular configuration

Objective:To research the relationship between essential hypertension(EH) with obstructive sleep apnea hypopnea syndrome(OSAHS)and the changes of left ventricular structure,as well as to analyze the influential factors.Methods:We randomly selected the total of 282 male patients with EH hospitalized in Hypertension Department of Anzhen Hospital from October 2007 to January 2010,at the age between 30 and 60.We analyzed their general information,chemical tests,and echocardiographic examination results,distinguished the differences of left ventricular structure in EH patients with OSAHS and without OSAHS,and observed the influential factors.Results:1.Compared with EH group,Body Mass Index,fasting blood glucose and 2-hour post-meal blood glucose in EH+OSAHS group were higher than those without OSAHS(P<0.05);serum total cholesterol,triglyceride,LDL and uric acid were higher in EH+ OSAHS group(P>0.05)and glomerular filtration rate was lower in the EH+OSAHS group(P>0.05).2.Left ventricular internal diastolic diameter,interventricular septal thickness,posterior wall thickness and left ventricular mass index in EH + OSAHS were higher than EH group,and the difference had statistic meaning(P<0.05).The incidence rate of LVH in EH+OSAHS group was obviously higher than EH group(41.0% vs.27.3%).3.Logistic regression analysis showed that: the risk factors related with LVH were OSAHS(OR=1.827,95%CI=1.006~3.220,P=0.048),the course of Hypertension(OR=2.122,95%CI=1.185~3.982,P=0.012),the grades of blood pressure(OR=3.797,95%CI=2.447~5.893,P=0.000).Conclusion:Compared with EH group,EH + OSAHS group had more severe changes of left ventricular structure;and OSAHS,course of Hypertension,grades of blood pressure might be the risk factors.