摘要
目的探讨持续气道正压通气（CPAP）治疗阻塞性睡眠呼吸暂停低通气综合征（OSAHS）合并难治性高血压（RH）的疗效及其可能机制。方法选择13例合并RH的中重度OSAHS患者，分别于CPAP治疗前及治疗3个月末测量睡前（22：00）、夜间（2：00）和清晨（6：00）的血压，并检测晨起（6：00）卧位血浆醛固酮（ALD）浓度和血浆肾素活性（PRA）。ALD、PRA检测采用放射免疫分析法。结果与CPAP治疗前相比，治疗第3个月末患者睡前、夜间和清晨血压（mmHg，1mmHg=0．133kPa）均显著下降（睡前135．5±2．8／84．2±4．6比152．2±19．2／98．9±15．6，夜间133．1±2．4／81．5±4．6比156．6±19．4／102．8±16．6，清晨151．5±3．0／81．2±3．2比172．1±23．7／98．1±6．5，均P〈0．01）；晨起卧位ALD浓度（pmol／L）明显降低（411±54比542±43，P〈0．01）；但PRA（ug·L^-1·h^-1）无明显变化（0．27±0．14比0．20±0．12，P=0．221）。结论CPAP治疗可显著改善OSAHS合并RH患者的血压并降低血浆ALD浓度。OSAHS患者的RH可能与血浆ALD浓度增高有关。
Objective To investigate the efficacy and possible mechanism of continuous positive airway pressure （CPAP） therapy upon blood pressure in patients with obstructive sleep apnea hypopnea syndrome （OSAHS） and resistant hypertension （RH）. Methods Thirteen OSAHS patients with RH were recruited. Before and after 3-month CPAP therapy, their blood pressures at 10：00 PM, 2：00 AM and 6：00 AM were measured and their morning plasma concentrations of aldosterone （ALD） and plasma renin activity （PRA） tested at supine position with radioimmunoassay. Results Compared with blood pressure parameters at pre-CPAP therapy, there was a significant decrease in blood pressure before sleep at the end of 3-month CPAP therapy [ （ 135.5 ± 2.8 ） / （ 84.2 ± 4.6） vs （ 152.2 ± 19.2） / （ 98.9 ± 15.6 ） mm Hg, P 〈 0.01], at night during sleep [ （133. 1 ±2.4）/（81.5 ±4.6） vs （156.6±19.4）/（102.8 ±16.6） mm Hg, P〈0.01] and in the early morning [ （151.5 ±3.0）/（81.2 ±3.2） vs （172.1 ±23.7）/（98.1 ± 6.5） mm Hg, P 〈 0.013. Comparison of plasma concentrations of ALD and PRA before and after 3-month CPAP therapy indicated that there was a significant difference in ALD [ （538 ±42） vs （408 ±53） pmol/L, P〈0.01] but not significantly different in PRA [ （0.27 ±0.14） ug·L^-1·h^-1 vs （0.20 ±0.12） ,P = 0.221 ]. Conclusions CPAP therapy could significantly improve RH and plasma ALD concentration. Elevated plasma ALD concentration is possibly involved in the pathogenesis of RH in OSAHS patients.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2009年第26期1811-1814,共4页
National Medical Journal of China
关键词
睡眠呼吸暂停
阻塞性
高血压
持续气道正压通气
醛固酮
Sleep apnea, obstructive
Hypertension
Continuous positive airway pressure
Aldosterone
