阻塞性睡眠呼吸暂停低通气综合征患者上气道骨骼肌损伤超微结构观察

摘要

Objective To observe the ultrastructure of the upper airway skeletal muscle from patients with obstructive sleep apnea hypopnea syndrome (OSAHS).Methods Sixteen OSAHS patients were recruited during Oct 2010 to Oct 2011.Ten patients with chronic tonsillitis were recruited as the control.Body mass index (BMI) was above 25 kg/m2 in all patients.The upper air way skeletal muscle cells were observed by a transmission electron microscope.The relation between the ultrastructure and apnea hypopnea index (AHI),the lowest saturation of blood oxygen (LSaO2) was detected by statistic analysis.Results AHI and LSaO2 in OSAHS patients were (53.6 ± 4.6)/h,and 0.754 ± 0.023 while that of the control group were (2.27 ± 1.1)/h and 0.968 ±0.014,which had statistically significant difference (t =8.84,t =6.90,P ＜ 0.01).In OSAHS patients,electron microscope showed that muscle fibers can not be identified with disordered arrangement of structure,some of mitochondria were severe swollen and disrupted,a lot of liposome was observed.In the control group,muscle fibers were identified with well arrangement,also there were some mitochondria swollen,but no liposome was found.The amount of liposome in upper airway skeletal muscle in OSAHS patients was analyzed with shape counting scale,it was found that it had positive correlation with AHI (r2 =0.761,P ＜0.01) but no correlation with BMI and LSaO2 (P ＞0.05).Conclusion Fatty change is the characteristic change of the upper airway skeletal muscle in OSAHS patients which was caused by hypoxia and vibration.%目的 观察阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者上气道骨骼肌损伤超微结构改变特点.方法 以2010年10月至2011年10月大连医科大学附属第一医院耳鼻咽喉科收治并行手术治疗的16例OSAHS中、重度患者为研究对象,行扁桃体切除术的慢性扁桃体炎患者10例为对照组.两组患者体质量指数(BMI)均＞25 kg/m2,差异无统计学意义.取两组患者上气道骨骼肌组织制作超薄切片,在透射电镜下观察两组骨骼肌超微结构改变,并将其与睡眠呼吸暂停低通气指数(AHI)、最低动脉血氧饱和度(LSaO2)进行相关性分析.结果 OSAHS组患者AHI平均((x)±s,下同)为(53.6±4.6)次/h,LSaO2为0.754±0.023,对照组AHI为(2.3±1.1)次/h,LSaO2为0.968±0.014,差异有统计学意义(t=8.84,t=6.90,P值均＜0.01).电镜下见OSAHS组上气道骨骼肌纤维排列紊乱,在严重的线粒体水肿及空泡化改变基础上发现细胞内脂肪小体即脂肪变.对照组肌原纤维排列整齐,Z线结构清晰,可见线粒体水肿,但未见脂肪小体.以形态计数法统计电镜放大30 000倍时每个视野下脂肪小体含量,发现16例OSAHS组患者平均每个视野脂肪小体含量为(16.1±1.2)％.脂肪小体含量与AHI呈正相关(r2 =0.761,P＜0.01),与BMI、LSaO2未见相关关系(P值均＞0.05).结论 骨骼肌脂肪变可能是OSAHS患者由于缺氧、振动引起上气道骨骼肌损伤的特征性改变.