摘要
目的探讨持续正压通气治疗对OSAHS合并高血压患者PDGF-BB、v WF水平的影响及其临床意义。方法收集2016年1月-2017年5月陕西省汉中市人民医院呼吸内科收治的73例鼾症患者的临床资料。根据是否合并高血压,将患者分为单纯OSAHS组,OSAHS合并高血压组。同时,纳入35名志愿者作为健康对照组,35例单纯高血压病1级患者为单纯高血压组。分析持续正压通气治疗前后,OSAHS合并高血压患者PDGF-BB、v WF水平的变化规律及其意义。结果 (1)与对照组、单纯高血压组患者比较,单纯OSAHS组与OSAHS合并高血压组患者的颈围、BMI、AHI、LSa O_2、Epworth评分显著较高,MSa O_2、ODI显著较低,差异具有统计学意义(P<0.05)。(2)与对照组、单纯OSAHS组患者比较,单纯高血压组与OSAHS合并高血压组患者MSBP、MDBP、PDGF-BB、v WF水平显著较高,差异具有统计学意义(P<0.05)。(3)OSAHS合并高血压患者经CPAP治疗后,Epworth评分、AHI、ODI、v WF显著降低,LSa O_2、MSa O_2明显升高,差异具有统计学意义(P<0.05),但MSBP、MDBP、PDGF-BB无明显变化(P>0.05)。(4)相关性分析显示,OSAHS合并高血压患者的PDGF-BB水平、v WF水平均与AHI、ODⅡ、Epworth评分、颈围、MSBP、MDBP呈明显正相关关系(r>0.3,P<0.05),与LSa O_2、MSa O_2呈明显负相关关系(r<-0.3,P<0.05)。(5)以v WF水平为应变量,以所有检测指标为自变量行多元逐步回归分析,可得最优方程回归方程:Y=15.541+2.968X1+0.285X2+0.256X3,Y:v WF水平,X1:Epworth评分,X2:MSBP,X3:MDBP。表明Epworth评分,MSBP,MDBP在OSAHS合并高血压患者v WF水平变化中其最重要作用。(6)以PDGF-BB水平为应变量,以所有检测指标为自变量行多元逐步回归分析,可得最优回归方程:Y=-289.083+27.089X1+0.926X4+1.859X2+1.611X3,Y:v WF水平,X1:Epworth评分,X2:MSBP,X3:MDBP,X4:AHI。这表明Epworth评分,MSBP,MDBP,AHI在OSAHS合并高血压患者PDGF-BB水平变化中其最重要作用。结论 OSAHS合并高血压患者的v WF水平、PDGF-BB水平显著升高,提示此类患者存在明显的血管重构和功能损伤。CAPA治疗不仅可改善患者呼吸功能,对改善血管重构也有一定的作用。
Objective To investigate the effect of CAPA on the level of PDGF-BB and v WF in patients with OSAHS combined with hypertension.Methods The clinical data of 73 patients with OSAHS,healthy volunteers and simple hypertension were collected.The changes and significance of PDGF-BB and v WF levels in patients before and after CAPA treatment were analyzed.Results（ 1） Compared with the control group and the simple hypertension group,the scores of neck circumference,BMI,AHI,LSa O_2 and Epworth in the OSAHS group and the hypertension group were significantly higher,MSa O_2 and ODI were significantly lower（ P〈0.05）.（2） Compared with the control group and the simple OSAHS group,the levels of MSBP,MDBP,PDGF-BB and v WF in the OSAHS combined with hypertension group were significantly higher（ P〈0.05）.（3） After CPAP treatment in OSAHS patients with hypertension,their Epworth score,AHI,ODI,and v WF decreased significantly,and LSa O_2 and MSa O_2 increased significantly（ P〈0.05）.（4） Correlation analysis showed that PDGF-BB level and v WF level in OSAHS patients with hypertension were positively correlated with AHI,ODⅡ,Epworth score,neck circumference,MSBP and MDBP,and negatively correlated with LSa O_2 and MSa O_2.（5） Taking v WF level as the dependent variable,the regression equation could be Y = 15.541 ＋ 2.968 X1 ＋ 0.285 X2 ＋ 0.256 X3,Y： v WF level,X1： Epworth score,X2： MSBP,X3： MDBP.（6） Taking the level of PDGF-BB as the dependent variable index,the regression equation could be Y=-289.083 ＋ 27.089 X1 ＋ 0.926 X4 ＋ 1.859 X2 ＋ 1.611 X3,Y： v WF level,X1： Epworth score,X2： MSBP,X3： MDBP,X4： AHI.Conclusion The level of v WF and PDGF-BB in OSAHS patients with hypertension is significantly higher,suggesting that there is obvious vascular remodeling and functional damage in these patients.CAPA therapy can not only improve the respiratory function of the patients,but also have some effect on the improvement of vascular remodeling.
作者
沈妍
李欣
SHEN Yan;LI Xin(Department of Respiratory Medicine,Hanzhoung People＇s Hospital,Hanzhong,Shaanxi 723000,China)
出处
《临床肺科杂志》
2018年第10期1845-1849,1853,共6页
Journal of Clinical Pulmonary Medicine
