CAJ | 학술논문

目的：探讨青年与中老年原发性高血压病伴阻塞性睡眠呼吸暂停低通气综合征（ OSAHS）患者的临床特点。方法回顾性分析2011年1月-2013年7月在新疆医科大学第一附属医院高血压科确诊的原发性高血压病伴OSAHS患者353例的临床资料，按年龄分为青年组（136例）和中老年组（217例），分析青年组和中老年组的临床一般资料、睡眠呼吸监测指标、24 h动态血压、肾素-血管紧张素-醛固酮系统活性的差异。结果（1）青年组与中老年组的性别、饮酒率、空腹血糖（ FBG）、三酰甘油（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、脂蛋白α〔LP （α）〕间差异均无统计学意义（ P＞0.05）；青年组吸烟率、体质指数（ BMI）高于中老年组，高密度脂蛋白胆固醇（HDL-C）低于中老年组，差异有统计学意义（P＜0.05）。（2）中老年组的睡眠呼吸暂停指数（AHI）、血氧饱和度＜85％时间（ TS＜85％）高于青年组，平均血氧饱和度（ MSaO2）、最低血氧饱和度（ LSaO2）低于青年组，差异有统计学意义（P＜0.05）。（3）青年组24 h平均收缩压（24hSBP）、24 h平均舒张压（24 hDBP）高于中老年组，而中老年组高血压病程长于青年组，差异有统计学意义（ P＜0.05）；青年组与中老年组的24 h平均脉压差（24 hPP）间差异无统计学意义（P＞0.05）。（4）青年组的血管紧张素A1（卧、立位）、血管紧张素A2（卧、立位）高于中老年组，醛固酮（卧位）低于中老年组，差异有统计学意义（ P＜0.05）；青年组与中老年组的立位醛固酮间差异无统计学意义（ P＞0.05）。结论在青年和中老年原发性高血压病伴OSAHS患者的防治过程中，青年患者应侧重于戒烟、减重、降低血管紧张素活性、加强降压力度；中老年患者则应侧重于降低醛固酮活性、采用无创气道正压通气治疗改善病情。目的：探討青年與中老年原髮性高血壓病伴阻塞性睡眠呼吸暫停低通氣綜閤徵（ OSAHS）患者的臨床特點。方法迴顧性分析2011年1月-2013年7月在新疆醫科大學第一附屬醫院高血壓科確診的原髮性高血壓病伴OSAHS患者353例的臨床資料，按年齡分為青年組（136例）和中老年組（217例），分析青年組和中老年組的臨床一般資料、睡眠呼吸鑑測指標、24 h動態血壓、腎素-血管緊張素-醛固酮繫統活性的差異。結果（1）青年組與中老年組的性彆、飲酒率、空腹血糖（ FBG）、三酰甘油（TG）、總膽固醇（TC）、低密度脂蛋白膽固醇（LDL-C）、脂蛋白α〔LP （α）〕間差異均無統計學意義（ P＞0.05）；青年組吸煙率、體質指數（ BMI）高于中老年組，高密度脂蛋白膽固醇（HDL-C）低于中老年組，差異有統計學意義（P＜0.05）。（2）中老年組的睡眠呼吸暫停指數（AHI）、血氧飽和度＜85％時間（ TS＜85％）高于青年組，平均血氧飽和度（ MSaO2）、最低血氧飽和度（ LSaO2）低于青年組，差異有統計學意義（P＜0.05）。（3）青年組24 h平均收縮壓（24hSBP）、24 h平均舒張壓（24 hDBP）高于中老年組，而中老年組高血壓病程長于青年組，差異有統計學意義（ P＜0.05）；青年組與中老年組的24 h平均脈壓差（24 hPP）間差異無統計學意義（P＞0.05）。（4）青年組的血管緊張素A1（臥、立位）、血管緊張素A2（臥、立位）高于中老年組，醛固酮（臥位）低于中老年組，差異有統計學意義（ P＜0.05）；青年組與中老年組的立位醛固酮間差異無統計學意義（ P＞0.05）。結論在青年和中老年原髮性高血壓病伴OSAHS患者的防治過程中，青年患者應側重于戒煙、減重、降低血管緊張素活性、加彊降壓力度；中老年患者則應側重于降低醛固酮活性、採用無創氣道正壓通氣治療改善病情。
목적：탐토청년여중노년원발성고혈압병반조새성수면호흡잠정저통기종합정（ OSAHS）환자적림상특점。방법회고성분석2011년1월-2013년7월재신강의과대학제일부속의원고혈압과학진적원발성고혈압병반OSAHS환자353례적림상자료，안년령분위청년조（136례）화중노년조（217례），분석청년조화중노년조적림상일반자료、수면호흡감측지표、24 h동태혈압、신소-혈관긴장소-철고동계통활성적차이。결과（1）청년조여중노년조적성별、음주솔、공복혈당（ FBG）、삼선감유（TG）、총담고순（TC）、저밀도지단백담고순（LDL-C）、지단백α〔LP （α）〕간차이균무통계학의의（ P＞0.05）；청년조흡연솔、체질지수（ BMI）고우중노년조，고밀도지단백담고순（HDL-C）저우중노년조，차이유통계학의의（P＜0.05）。（2）중노년조적수면호흡잠정지수（AHI）、혈양포화도＜85％시간（ TS＜85％）고우청년조，평균혈양포화도（ MSaO2）、최저혈양포화도（ LSaO2）저우청년조，차이유통계학의의（P＜0.05）。（3）청년조24 h평균수축압（24hSBP）、24 h평균서장압（24 hDBP）고우중노년조，이중노년조고혈압병정장우청년조，차이유통계학의의（ P＜0.05）；청년조여중노년조적24 h평균맥압차（24 hPP）간차이무통계학의의（P＞0.05）。（4）청년조적혈관긴장소A1（와、립위）、혈관긴장소A2（와、립위）고우중노년조，철고동（와위）저우중노년조，차이유통계학의의（ P＜0.05）；청년조여중노년조적립위철고동간차이무통계학의의（ P＞0.05）。결론재청년화중노년원발성고혈압병반OSAHS환자적방치과정중，청년환자응측중우계연、감중、강저혈관긴장소활성、가강강압력도；중노년환자칙응측중우강저철고동활성、채용무창기도정압통기치료개선병정。
O bjective To discuss the clinical features of young , middle and old aged patients with essential hyperten -sion and OSAHS.Methods The retrospective analysis was conducted of the clinical data of 353 patients with essential hyperten-sion and OSAHS diagnosed by the Hypertension Department of the First Teaching Hospital of Xinjiang Medical University from January 2011 to July 2013.The patients were divided into young group (136 patients) and the middle and old aged group (217 patients) by age and then the differences of general clinical data , sleep apnea monitoring indexes , 24-hour ambulatory blood pressure, renin-angiotensin-aldosterone system activity between the young group and the middle and old aged group were ana -lyzed.Results (1) The differences of sex composition ratio , drinking composition ratio, fasting blood-glucose (FBG), tria-cylglycerol ( TG) , total cholesterol ( TC) , low-density lipoprotein cholesterol ( LDL-C) and lipoprotein a 〔LP (α)〕 of the young group and middle and old aged group were not statistically significant ( P>0.05); the smoking composition ratio and body mass index ( BMI) of the young group were higher than that of the middle and old aged group and the high -density lipoprotein cholesterol( HDL-C) of the young group was lower than that of the middle and old aged group , and the differences were statisti-cally significant (P<0.05); (2) the apnea hypopnea index (AHI) and time of oxyhemoglobin saturation of less than 85%(TS <85%) of the middle and old aged group were higher than that of the young group and the mean oxygen saturation ( MSaO2 ) and the lowest oxygen saturation ( LSaO2 ) of the middle and old aged group were lower than that of the young group , the differences between the two groups were statistically significant (P<0.05); (3) the 24-hour mean systolic blood pressure (24 hSBP) and 24-hour mean diastolic blood pressure (24 hDBP) of the young group were higher than those of the middle and old aged group and the hypertension course of the middle and old aged group was longer than that of the young group , the differences were statis-tically significant(P>0.05); the difference of the 24-hour mean pulse pressure (24 hPP) between the young group and the middle and old aged group was not statistically significant (P>0.05); (4) the levels of angiotensin A1 and A2 of the young group in supine and standing was higher than that of the middle and old aged group and the level of aldosterone of the young group in supine was lower than that of the middle and old aged group , the differences were statistically significant ( P<0.05); and there was no difference of the levels of aldosterone in standing between the two groups ( P>0.05) .Conclusion During the pre-ventive treatment of the young , middle and old aged patients with essential hypertension and OSAHS , attentions should be paid to quitting smoking , losing weight , reducing the angiotensin activity and strengthening the depressurization efforts for the young pa -tients; attentions should be paid to reducing the aldosterone activity and adopting non -invasive positive airway pressure to modify the disease for the middle and old aged patients.