张凤英

[摘要] 目的 探讨H型高血压合并阻塞性睡眠呼吸暂停低通气综合征患者（OSAHS）的颈动脉硬化程度。 方法 选择2014年10月～2016年10月初次诊断为H型高血压的住院患者114例。患者均符合H型高血压诊断標准。根据OSAHS诊断标准分为对照组（58例）和H型高血压合并OSAHS组（56例）。颈动脉超声检查患者颈动脉内膜-中膜厚度（IMT）、斑块以及狭窄情况。检测患者血浆同型半胱氨酸（Hcy）、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇等生化指标。 结果 H型高血压合并OSAHS组总胆固醇含量以及低密度脂蛋白胆固醇含量较对照组显著升高，差异有统计学意义（P<0.05）。H型高血压合并OSAHS组正常者比例显著低于对照组，颈动脉增厚26例，颈动脉斑块14例，颈动脉狭窄12例，所占比例略高于对照组（增厚18例，斑块13例，狭窄9例），差异无统计学意义（P>0.05）。 结论 H型高血压合并OSAHS双重作用，颈动脉硬化程度较为严重，应重视H型高血压合并OSAHS患者颈动脉情况。

[关键词] H型高血压；阻塞性睡眠呼吸暂停低通气综合征；颈动脉硬化；颈动脉内膜-中膜厚度

[中图分类号] R766；R544.1 [文献标识码] B [文章编号] 1673-9701（2017）24-0046-03

[Abstract] Objective To investigate the degree of carotid atherosclerosis in the patients with H-type hypertension complicated with obstructive sleep apnea hypopnea syndrome（OSAHS）. Methods A total of 114 inpatients with H-type hypertension who were firstly diagnosed from October 2014 to October 2016 were selected. The patients were all in line with H-type hypertension diagnostic criteria. According to OSAHS diagnostic criteria， the patients were divided into control group（58 cases） and H-type hypertension complicated with OSAHS group（56 cases）. Carotid artery intima-media thickness（IMT）， plaque and stenosis were tested via carotid artery ultrasonography. Plasma homocysteine（Hcy）， total cholesterol， triglyceride， high density lipoprotein cholesterol， low density lipoprotein cholesterol and other biochemical indicators were tested in the patients. Results The contents of total cholesterol and low-density lipoprotein cholesterol in H-type hypertension complicated with OSAHS group were significantly higher compared with control group， and the differences were statistically significant（P<0.05）. The normal rate of the H-type hypertension complicated with OSAHS group was lower than that of the control group. There were 26 patients with carotid artery thickening in H-type hypertension complicated with OSAHS group， with carotid plaque in 14 cases， carotid artery stenosis in 12 cases， a little bit higher than those in the control group（thickening=18 cases， plaque=13 cases， stenosis=9 cases）， and the differences were not statistically significant（P>0.05）. Conclusion H-type hypertension complicated with OSAHS have double effects， and the degree of carotid atherosclerosis is more severe. Therefore， attention should be paid to the carotid artery in the patients with H-type hypertension complicated with OSAHS.

[Key words] H-type hypertension； Obstructive sleep apnea hypopnea syndrome（OSAHS）； Carotid atherosclerosis； Carotid artery intima-media thickness（IMT）endprint

近年来，社会发展速度加快，人们工作压力变大，生活习惯及饮食结构也发生了很大变化，导致高血压患者增多，并且在我国高血压患者中约75%的患者伴有血浆同型半胱氨酸（homocystein，Hcy）水平升高，即H型高血压[1]。研究发现，Hcy水平增高是高血压的一个新的危险因素[2，3]，也是脑卒中及动脉粥样硬化的独立危险因素[4]。阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome，OSAHS）是临床上极其常见的一种具有潜在致命危险的睡眠呼吸障碍性疾病。研究发现，OSAHS可导致高血压和冠心病，约70%左右的OSAHS患者合并有高血压，而40%左右的高血压患者同时伴有OSAHS[5]。……