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首页> 中文期刊> 《中国全科医学》 >青年和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患者的临床特点研究

青年和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患者的临床特点研究

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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。%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.

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