中华耳鼻咽喉头颈外科杂志
中華耳鼻嚥喉頭頸外科雜誌
중화이비인후두경외과잡지
CHINESE JOURNAL OF OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY
2011年
8期
638-641
,共4页
李赛楠%杨怀安%姜学钧%任重
李賽楠%楊懷安%薑學鈞%任重
리새남%양부안%강학균%임중
睡眠呼吸暂停,阻塞性%腭肌%显微镜检查,电子,透射
睡眠呼吸暫停,阻塞性%腭肌%顯微鏡檢查,電子,透射
수면호흡잠정,조새성%악기%현미경검사,전자,투사
Sleep apnea,obstructive%Palatal muscles%Microscopy,electron,transmisson
目的 研究不同程度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患者的腭咽肌在透射电镜下的病理形态学改变,探讨腭咽组织在其发病机制中的作用.方法 38例接受悬雍垂腭咽成形术治疗的OSAHS患者(轻度组10例,中度组13例,重度组15例),对照组为5例无口咽部阻塞疾病行腭肿物或腭良性肿瘤切除术的成人患者.透射电镜下观察腭咽肌形态变化特点.结果 透射电镜下对照组腭咽肌的肌纤维排列规整,肌间线粒体基本正常.OSAHS轻度组腭咽肌的肌原纤维排列规则,Z线平直,大多线粒体结构正常;中度组肌纤维走行紊乱,Z线距离缩短、扭曲,线粒体大量空泡变性;重度组肌纤维呈点状或片状排列,Z线扭曲或消失,细胞器崩解,线粒体呈絮状改变,甚至消失,肌间可见脂质沉积.对照及OSAHS轻、中、重4组腭咽肌的肌纤维排列紊乱的发生比率分别为0、3/10、10/13、15/15,发生线粒体变性的比率为0、2/10、8/13、14/15,均有随病情程度加重而超微结构改变发生率增高的趋势.结论 OSAHS病情程度与腭咽肌病理形态变化有关,肌肉病变是OSAHS发病的重要环节,慢性间歇缺氧等病理损害可能进一步加重肌肉病变.
目的 研究不同程度阻塞性睡眠呼吸暫停低通氣綜閤徵(obstructive sleep apnea hypopnea syndrome,OSAHS)患者的腭嚥肌在透射電鏡下的病理形態學改變,探討腭嚥組織在其髮病機製中的作用.方法 38例接受懸雍垂腭嚥成形術治療的OSAHS患者(輕度組10例,中度組13例,重度組15例),對照組為5例無口嚥部阻塞疾病行腭腫物或腭良性腫瘤切除術的成人患者.透射電鏡下觀察腭嚥肌形態變化特點.結果 透射電鏡下對照組腭嚥肌的肌纖維排列規整,肌間線粒體基本正常.OSAHS輕度組腭嚥肌的肌原纖維排列規則,Z線平直,大多線粒體結構正常;中度組肌纖維走行紊亂,Z線距離縮短、扭麯,線粒體大量空泡變性;重度組肌纖維呈點狀或片狀排列,Z線扭麯或消失,細胞器崩解,線粒體呈絮狀改變,甚至消失,肌間可見脂質沉積.對照及OSAHS輕、中、重4組腭嚥肌的肌纖維排列紊亂的髮生比率分彆為0、3/10、10/13、15/15,髮生線粒體變性的比率為0、2/10、8/13、14/15,均有隨病情程度加重而超微結構改變髮生率增高的趨勢.結論 OSAHS病情程度與腭嚥肌病理形態變化有關,肌肉病變是OSAHS髮病的重要環節,慢性間歇缺氧等病理損害可能進一步加重肌肉病變.
목적 연구불동정도조새성수면호흡잠정저통기종합정(obstructive sleep apnea hypopnea syndrome,OSAHS)환자적악인기재투사전경하적병리형태학개변,탐토악인조직재기발병궤제중적작용.방법 38례접수현옹수악인성형술치료적OSAHS환자(경도조10례,중도조13례,중도조15례),대조조위5례무구인부조새질병행악종물혹악량성종류절제술적성인환자.투사전경하관찰악인기형태변화특점.결과 투사전경하대조조악인기적기섬유배렬규정,기간선립체기본정상.OSAHS경도조악인기적기원섬유배렬규칙,Z선평직,대다선립체결구정상;중도조기섬유주행문란,Z선거리축단、뉴곡,선립체대량공포변성;중도조기섬유정점상혹편상배렬,Z선뉴곡혹소실,세포기붕해,선립체정서상개변,심지소실,기간가견지질침적.대조급OSAHS경、중、중4조악인기적기섬유배렬문란적발생비솔분별위0、3/10、10/13、15/15,발생선립체변성적비솔위0、2/10、8/13、14/15,균유수병정정도가중이초미결구개변발생솔증고적추세.결론 OSAHS병정정도여악인기병리형태변화유관,기육병변시OSAHS발병적중요배절,만성간헐결양등병리손해가능진일보가중기육병변.
Objective To study the pathologic changes of the palatopharyngeal muscles with transmission electronmiscroscopy (TEM) in patients with obstructive sleep apnea hypopnea syndrome (OSAHS), the role of the above muscle in OSAHS pathogenesis was discussed. Methods Thirty-eight palatopharyngeal muscle from OSAHS patients receiving uvulopalatopharyngoplasty (UPPP) were collected in in-patient department of Chinese Medical University and five palatal tumor patients receiving resection without snoring were chosen as the control. The palatophryngeal muscle fiber and the feature of changes in mitochondrial morphology were observed by TEM. Results The pathological changes were not observed in the normal control group. The muscle fibers were regularly arranged, and the mitochondrial between muscles were normal. The palatopharyngeal myofibrillar in mild OSAHS group was regularly arranged. The Z lines were straight, and most mitochondria structure were normal. In the moderate group, the myofibrillar was disorganized, and the Z lines were shortened or distorted. The myofibrillar in severe group was disorganized,similar to point-like or flake, and the Z lines and the structures of sarcomeres were disppearered. And organelle were disintegrated and mitochondria were disappeared similar to flocculent. There existed obvious fatty infiltration in the palatopharyngeal muscle. In the control, mild, moderate and severe group,pharyngeal muscle fiber disarrangement of the occurrence rate was 0, 2/10, 8/13, 14/15, the occurrence rate of mitochondrial degeneration was 0, 2/10, 8/13, 14/15, increased with the severity of the ultrastructural changes in the trend of increasing incidence. Conclusions The degree of OSAHS is correlated with the pathological changes of palatopharyngeal muscles. Incidence of myopathy is an important part of OSAHS secondary to chronic intermittent hypoxia in OSAHS and other pathological lesions, but also an important reason for increasing pharyngeal collapse.
