摘要
目的研究高血压合并不同严重程度的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者缺氧参数与血管内皮功能障碍的关联。方法采用横断面研究设计。纳入于2020年4月至2023年7月在泰达国际心血管病医院高血压科就诊或于2023年12月至2024年9月在天津康汇医院高血压科就诊的高血压患者629例,年龄为(39.21±8.87)岁,男性占77.6%(488/629),女性占22.4%(141/629)。对患者进行夜间睡眠呼吸监测,根据呼吸暂停低通气指数(AHI)将患者分为单纯高血压组(AHI<5次/h,n=205)、高血压合并轻度OSAHS组(AHI 5~<15次/h,n=227)、高血压合并中度OSAHS组(AHI 15~<30次/h,n=112)、高血压合并重度OSAHS组(AHI≥30次/h,n=85)。通过肱动脉超声测定血流介导的血管舒张功能(FMD)来评估患者的血管内皮功能障碍情况。采用多因素线性回归分析方法分析缺氧参数与内皮功能障碍之间的关系。采用受试者操作特征(ROC)曲线初步评价血氧饱和度低于90%的时间(TS90%)诊断高血压合并重度OSAHS患者发生严重内皮功能障碍的性能。结果高血压合并轻度、中度、重度OSAHA患者的FMD分别为(4.38±2.25)%、(4.20±1.96)%、(3.95±2.04)%,低于单纯高血压组患者的(5.56±2.66)%(F=15.465,P<0.001)。多因素线性回归分析显示,在校正了估算的肾小球滤过率(eGFR)、尿酸等因素后,高血压合并重度OSAHS组中TS90%对FMD有独立影响(B=-0.008,P=0.006)。高血压合并重度OSAHS组中TS90%诊断严重内皮功能障.碍的ROC曲线下面积为0.692(95%CI 0.579~0.806,P<0.001),最佳截断值为30.25 min,灵敏度为80.43%,特异度为56.41%。结论在高血压合并重度OSAHS患者中,TS90%是内皮功能障碍的独立影响因素。
Objective To investigate the association between hypoxia parameters and vascular endothelial dysfunction in patients with hypertension combined with obstructive sleep apnea-hypopnea syndrome(OSAHS)of different severity.Methods A cross-sectional study was conducted.A total of 629 hypertensive patients,aged(39.21±8.87)years,who visited the Hypertension Department of TEDA International Cardiovascular Hospital from April 2020 to July 2023 or Tianjin Kanghui Hospital from December 2023 to September 2024,were included.Male patients accounted for 77.6%(488/629)and female patients accounted for 22.4%(141/629).The patients underwent portable sleep monitoring and were categorized into 4 groups based on the apnea-hypopnea index(AHI):essential hypertension without OSAHS group(AHI<5 events/hour,n=205),hypertension with mild OSAHS group(AHI 5 to<15 events/hour,n=227),hypertension with moderate OSAHS group(AHI 15 to<30 events/hour,n=112),and hypertension with severe OSAHS group(AHI≥30 events/hour,n=85).Vascular endothelial function was assessed via brachial artery flow-mediated dilation(FMD).Multivariate linear regression analysis was used to assess the correlation between hypoxia parameters and endothelial dysfunction.Receiver operating characteristic(ROC)curve analysis was used to preliminarily evaluate the diagnostic performance of the time spent below oxygen saturation of 90%(TS90%)on severe endothelial dysfunction in hypertensive patients with severe OSAHS.Results FMD in the hypertension with mild,moderate,and severe OSAHS group was(4.38±2.25)%,(4.20±1.96)%,and(3.95±2.04)%,respectively,which was lower than that in the essential hypertension group[(5.56±2.66)%](F=15.465,P<0.001).Multivariate linear regression analysis showed that,after adjusting for estimated glomerular filtration rate(eGFR),uric acid,and other factors,TS90%had an independent impact on FMD in the hypertension with severe OSAHS group(B=−0.008,P=0.006).In the hypertension with severe OSAHS group,the area under the ROC curve(AUC)for TS90%diagnosing severe endothelial dysfunction was 0.692(95%CI:0.579 to 0.806;P<0.001).The optimal cut-off value was 30.25 minutes,with a sensitivity of 80.43%and a specificity of 56.41%.Conclusion In hypertensive patients with severe OSAHS,TS90%is an independent influencing factor for endothelial dysfunction.
作者
尹诗琦
魏茂提
侴宏达
屈春乐
石雷雷
李玉明
杨宁
YIN Shiqi;WEI Maoti;CHOU Hongda;QU Chunle;SHI Leilei;LI Yuming;YANG Ning(Graduate School of Chengde Medical University,Chengde,Hebei 067000,China;Hypertension Department,TEDA International Cardiovascular Hospital;Hypertension Department,Tianjin Kanghui Hospital;Cardiology Department,Tianjin Thoracic Hospital;Graduate School of Tianjin Medical University)
出处
《中华高血压杂志(中英文)》
北大核心
2025年第8期758-765,共8页
Chinese Journal of Hypertension
