CAJ | 학술논문

目的调查睡眠呼吸暂停相关性高血压中颈动脉粥样硬化及不稳定斑块的患病率及影响因素.方法 603例诊断为睡眠呼吸暂停相关性高血压入选病例组,根据睡眠呼吸紊乱指数(AHI)进一步分为轻(AHI 5～15)、中(AHI 15～30)、重(AHI≥30)3组,AHI＜5者为对照组.根据颈动脉超声判断斑块性质.结果 4组间性别不匹配；颈动脉粥样硬化在中、重度组高于对照组(P＜0.01),不稳定斑块在组间无差异；对该人群颈动脉粥样硬化可能的危险因素进行因子分析,共提取6个公因子,以各因子得分为因变量进入逐步logistic回归,提示阻塞性睡眠呼吸暂停、血脂( TC、LDL-C)为颈动脉粥样硬化的危险因素,OR分别为1.36(95％ CI 1.15～1.59)、1.31 (95％ CI1.12～1.54),血脂为不稳定斑块的危险因素,OR为1.30(95％ CI 1.06～ 1.58).结论睡眠呼吸暂停相关性高血压中颈动脉粥样硬化可能与阻塞性睡眠呼吸暂停独立相关,而不稳定斑块形成则主要与脂代谢紊乱有关.
목적 조사수면호흡잠정상관성고혈압중경동맥죽양경화급불은정반괴적환병솔급영향인소.방법 603례진단위수면호흡잠정상관성고혈압입선병례조,근거수면호흡문란지수(AHI)진일보분위경(AHI 5～15)、중(AHI 15～30)、중(AHI≥30)3조,AHI＜5자위대조조.근거경동맥초성판단반괴성질.결과 4조간성별불필배；경동맥죽양경화재중、중도조고우대조조(P＜0.01),불은정반괴재조간무차이；대해인군경동맥죽양경화가능적위험인소진행인자분석,공제취6개공인자,이각인자득분위인변량진입축보logistic회귀,제시조새성수면호흡잠정、혈지( TC、LDL-C)위경동맥죽양경화적위험인소,OR분별위1.36(95％ CI 1.15～1.59)、1.31 (95％ CI1.12～1.54),혈지위불은정반괴적위험인소,OR위1.30(95％ CI 1.06～ 1.58).결론 수면호흡잠정상관성고혈압중경동맥죽양경화가능여조새성수면호흡잠정독립상관,이불은정반괴형성칙주요여지대사문란유관.
Objective To investigate the risk factors and morbidity of carotid atherosclerosis (CA) and unstable plague in patients with sleep apnea-related hypertension (SA-RH).Methods A total of 603 SA-RH subjects screened by polysomnography according to apnea hypopnea index (AHI) were recruited and divided into 3 groups:mild (AHI 5-15 ),moderate (AHI 15-30) and severe (AHI ≥ 30) group,with hypertensive patients with AHI less than 5 served as control.CA was determined by doppler ultrasound as formation of plaque and/or intima-media thickness more than 0.9 mm.Unstable atheroma plaque (UAP) was defined as low echo plaque and/or admixing echo plaque.Results Gender,age,BMI and blood pressure were not matched among groups.The prevalence of CA increased in moderate and severe SA-RH than that in control ( P ＜ 0.01 ) with no significant difference for UAP among groups.Factor analysis was performed to extracted common factors that may influence CA and UAP,such as factor 1-6,represent obstructive sleep apnea (OSA),dyslipidemia (TC,LDL),BMI,blood pressure,age and duration of disease and dyslipidemia (TG,HDL) respectively.Logistic analysis show that OSA and dyslipidemia (TC,LDL) increased the risk of CA,with OR 1.36(95％ CI 1.15-1.59),1.31 (95％ CI 1.12-1.54)respectively,and dyslipidemia (TC,LDL) increased the risk of UAP,with OR 1.30 (95％ CI 1.06-1.58).Conclusions In SA-RH populations,higher prevalence of CA may be associated with severity of OSA independently,meanwhile the formation of UAP may be mainly associated with dyslipidemia.