【作者】 王宏；

【导师】 杨松青；

【作者基本信息】 吉林大学 ， 临床医学， 2012， 硕士

【摘要】 睡眠呼吸暂停综合征是指在夜间睡眠情况下出现的，由于气道受阻或其他原因引起的呼吸暂停和/或低通气，导致机体处于低氧合并高碳酸血症的状态，从而产生多种病理生理改变和临床表现的一组综合征。是临床上常见的一种疾病，严重威胁人类的健康。睡眠呼吸暂停综合征与动脉粥样硬化发生可能存在相关性。本研究以单纯睡眠呼吸暂停综合征患者及伴有高血压睡眠呼吸暂停综合征组患者为研究对象，应用二维超声方法检测颈动脉内中膜厚度，应用血管回声跟踪技术检测颈动脉弹性参数，以探讨睡眠呼吸暂停综合征与动脉弹性变化之间的关系，为进一步研究睡眠呼吸暂停综合征的病理生理和临床上对睡眠呼吸暂停综合征的治疗提供资料。研究对象分为A组（正常对照组）：健康成年人36例，其中男性22例，女性14例，平均年龄为46±8.87岁；B组（单纯睡眠呼吸暂停综合征组）：诊断为睡眠呼吸暂停综合征的患者36例，其中男性26例，女性10例，平均年龄为45.67±12.01岁；C组（睡眠呼吸暂停综合征合并高血压组）：诊断为睡眠呼吸暂停综合征同时伴有高血压的患者30例，其中男性21例，女性9例，平均年龄为49.13±17.81岁。对研究对象进行各项目检测。检测项目及方法包括：血压；应用二维超声观察颈总动脉及颈内、外动脉有无斑块形成，测量颈总动脉内中膜厚度（IMT）；应用超声ET技术检测左右侧颈总动脉的弹性参数，包括动脉僵硬度指数（β）、血管压力-应变弹性系数（Eρ）、血管顺应性（AC）、脉搏波传导速度（PWVβ）。检测结果：1.左右侧颈总动脉IMT值：C组＞B组＞A组，各组间比较有显著性差异；2.左右侧颈总动脉的β和Eρ值：C组＞B组＞A组，各组间比较有显著性差异；3.左右侧颈总动脉的AC值：C组＜B组＜A组，各组间比较有显著性差异；4.左右侧颈总动脉的PWVβ值：C组、B组＞A组，A组与B组比较、A组与C组间比较，均有显著性差异； B组与C组比较，无显著性差异；5.根据颈动脉IMT和斑块发生情况将B、C组研究对象各分为三组，B0、C0组：IMT＜0.09mm，无斑块； B1、C1组：IMT>0.09mm，无斑块；B2、C2组：有斑块。在B组中，左右侧颈总动脉β值：B2组＞B0、B1组，B2组与B0、B1组比较，均具有显著性差异；在C组中，β、Eρ值：C1组、C2组＞C0组，C1组、C2组分别与C0组比较，差异均具有显著性，AC值：C2组＜C0组，C2与C0组比较，差异具有显著性，PWVβ值：C2组＞C0组，C2组与C0组比较，差异均具有显著性。本文研究结果显示：睡眠暂停综合征是导致动脉粥样硬化发生的一个危险因素，首先可以导致动脉功能改变，使弹性减退；进一步还可以引起动脉血管形态学改变，包括动脉IMT增厚和动脉粥样斑块形成。睡眠呼吸暂停综合征患者由于反复的低氧-复氧导致血管内皮细胞受损，内皮细胞功能失调，代谢改变，同时血脂代谢异常、血液粘稠度的增加等病理生理改变，这些都促进了动脉粥样硬化的发生，使动脉弹性减低、动脉粥样斑块形成。睡眠暂停综合征合并高血压时可以使动脉功能和形态改变加重，促进动脉粥样硬化的发生。本项研究应用E-Tracking技术对睡眠暂停综合征患者的动脉僵硬度β、弹性系数Eρ、脉搏波传导速度PWVβ及顺应性AC值等血管弹性指标进行检测，目前这方面的研究资料很少。E-Tracking技术能够自动跟踪动脉血管壁收缩期及舒张期的管径变化，自动计算各弹性系数数值，使计算结果更加准确。E-Tracking作为一种无创的检查方式，能够早期、准确的评价睡眠呼吸暂停综合征患者外周动脉弹性，为睡眠呼吸暂停综合征患者动脉弹性改变的早期诊断和治疗提供信息。更多还原

【Abstract】 Sleep apnea syndrome is that sleep apnea and/or hypopnea appear in thenight due to airway obstruction or other cause. The syndrome makes the bodyin a low oxygen mixed hypercapnia state and result in a variety of pathologicalchanges and clinical manifestations. It is common seen in clinical and is aserious threat to human health. Sleep apnea syndrome may be correlated witharterial atherosclerosis. This study takes patients of simple sleep apneasyndrome and the sleep apnea syndrome with hypertension as the researchobjects. We use Two-dimensional ultrasound to detect carotid IMT, and useE-Tracking technology to text the carotid elasticity of the research objects. Thepurpose is to study the relationship between SAS and the carotid arteryelasticity，and provide information for the further study of pathothysiology andthe treatment of sleep apnea syndrome in clinical.The all of research objects included three groups：group A（normal controlgroup）：healthy adults36cases，male22cases，female14cases，with anaverage age46±8.87years old；group B（simple sleep apnea syndrome patientsgroup）: sleep apnea syndrome patients of36cases, male26cases, female10cases, with an average age of45.67±12.01years old; group C(sleep apneasyndrome patients with hypertension): sleep apnea syndrome patients withhypertension30cases, the male21cases, female9cases, with an average ageof49.13±17.81years old. The test content and methods: Blood pressure; Weuse two-dimensional ultrasound to examine the plaque of the common carotidartery、internal carotid artery and the external carotid artery, measure IMT ofcommon carotid artery; We use E-Tracking technology to test elasticparameters of bilateral common carotid artery of all research objects. Elastic parameters include stiffness parameter (β)、Arterial compliance(AC)、Elasticitymodulus(Eρ)、one-point pulse wave velocity calculated from β value(PWV β).Texting results:1. IMT values of left and right common carotid artery：Group C＞Group B＞Group A, there are significant difference among the threegroups;2.β and Eρ values of left and right common carotid artery: Group C＞Group B＞Group A, there are significant difference among the three groups;3.AC values of left and right common carotid artery: Group C＜Group B＜Group A, there are significant difference among the three groups;4. PWV βvalues of left and right common carotid artery：Group B、Group C＞Group A，Group A compared with Group B and C, there are significant difference; GroupB and Group C compared, there is not significant difference;5. According toIMT and whether the carotid plaques of carotid artery exist, Group B and Cwere divided into three groups respectively, Group B0and C0: IMT＜0.09mm,no plaques; Group B1and C1: IMT＞0.09mm, no plaques; Group B2and C2:have plaques. In the Group B, β values of left and right common carotid artery:Group B2＞Group B0、GroupB1，Group B2compared with Group B0and B1,all have significant difference; In the Group C, β and Eρ values of left and rightcommon carotid artery：Group C1、GroupC2＞Group C0, Group C1、C2compared with Group C0, there are significant difference；AC value：Group C2＜Group C0，Group C2compared with Group C0，there are great significantdifference，PWVβ value：Group C2＞Group C0，there are great significantdifference.The results of this study show that sleep apnea syndrome is a risk factor ofatherosclerosis. Firstly the disease can lead to the change of the arteryfunction， make the elasticity of artery decline; Furtherly it can causemorphological change of arteries, including the artery IMT thickening and atherosclerosis plaque formation. Pathophysiological changes of the sleepapnea syndrome patients which include vascular endothelial cell damage、endothelial function disorder and metabolic changes, dyslipidedia, increase ofblood viscosity and so on for the reason of repeated hypoxia-reoxygenationcontributed to the occurrence of atherosclerosis：the change of arterial elasticityand the formation of atherosclerotic plaque. Sleep apnea syndrome withhypertension can make the change of function and morphology of the arteriesaggravated, promote the occurrence of atherosclerosis.In this study we use E-Tracking technology to text stiffness parameter(β)、Elasticity modulu（sEρ）、one-point pulse wave velocity calculated from β value（PWVβ）and Arterial compliance(AC) of the artery of sleep apnea syndromepatients. At present, the research data about the artery elasticity of sleep apneasyndrome patients is less relatively. The E-Tracking technology can track thechange of systolic and diastolic diameter of the artery walls automatically, andcalculate some elastic coefficient values, the results are more accurate. TheE-Tracking technology can evaluate the change of the peripheral arteryelasticity early and accurately in sleep apnea syndrome patients as anoninvasive examination way, and provide information for the diagnosis andtreatment of arterial elasticity change in sleep apnea syndrome patients early.更多还原