儿童阻塞性睡眠呼吸暂停低通气综合征血压变异性和血清中炎性因子表达水平及临床意义

摘要

目的 探讨儿童阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome, OSAHS)血压变异性和血清中炎性因子表达水平及临床意义.方法 选取2014年6月-2016年6月内蒙古医科大学第二附属医院收治的诉有睡眠打鼾及白天嗜睡等症状且符合儿童OSAHS诊断标准65例作为儿童OSAHS组,无上述症状常规体检正常儿童22例作为正常对照组,两组均进行夜间多导睡眠监测(polysomnography, PSG).按疾病不同程度将65例儿童OSAHS分为轻度OSAHS组(27例)、中度OSAHS组(23例)和重度OSAHS组(15例)3组.观察比较正常对照组和儿童OSAHS组一般资料,正常对照组与不同程度儿童OSAHS 3组各血压参数、心率、血氧饱和度和血清炎性因子水平,并对儿童OSAHS严重程度与血压变异性及其他各危险因素的相关性进行分析.结果 正常对照组与儿童OSAHS组体重指数及OSAHS家族史比较差异有统计学意义(P<0.05).正常对照组与不同程度儿童OSAHS 3组24 h平均血压、白天平均血压、夜间平均血压、夜间血压下降率、非勺型血压率、血氧饱和度及血清肿瘤坏死因子(TNF)-α、白细胞介素(IL)-4、IL-6及IL-8水平总体比较差异均有统计学意义(P<0.05).不同程度儿童OSAHS 3组24 h平均血压、白天平均血压、夜间平均血压、非勺型血压率及血清TNF-α、IL-4、IL-6、IL-8水平均高于对照组,差异有统计学意义(P<0.05);且儿童OSAHS越严重24 h平均血压、白天平均血压、夜间平均血压、非勺型血压率及血清TNF-α、IL-4、IL-6、IL-8水平越高,不同程度儿童OSAHS 3组间同一指标两两比较差异均有统计学意义(P<0.05).夜间血压下降率不同程度儿童OSAHS 3组均明显低于正常对照组,差异有统计学意义(P<0.05);且儿童OSAHS越严重夜间血压下降率越低,不同程度儿童OSAHS 3组间两两比较差异均有统计学意义(P<0.05).血氧饱和度重度儿童OSAHS组明显低于正常对照组、轻度儿童OSAHS组和中度儿童OSAHS组,差异均具有统计学意义(P<0.05).协方差分析显示夜间平均血压、非勺型血压率与儿童OSAHS严重程度呈正相关(P<0.05),而夜间血压下降率与儿童OSAHS严重程度呈负相关(P<0.05).Pearson相关分层分析显示,体重指数及血清TNF-α、IL-4、IL-6、IL-8水平与儿童OSAHS严重程度呈正相关(P<0.05).结论 儿童OSAHS和高血压、血清炎性因子水平密切相关,夜间平均血压、非勺型血压率、体重指数及血清TNF-α、IL-4、IL-6、IL-8水平与儿童OSAHS严重程度呈正相关,而夜间血压下降率与儿童OSAHS严重程度呈负相关.%Objective To investigate blood pressure variability and expressions and clinical significances of serum inflammatory factors in children with obstructive sleep apnea hypopnea syndrome (OSAHS).Methods A total of 65 OSAHS children with symptoms of snoring during sleeping and daytime sleepiness admitted during June 2014 and June 2016 were selected as OSAHS group, and other 22 healthy children without above symptoms were selected as control group, and children in both groups were monitored by overnight polysomnography (PSG).The 65 children with OSAHS were divided into mild OSAHS subgroup (n=27), moderate OSAHS subgroup (n=23) and severe OSAHS subgroup (n=15) according to OSAHS grades.General informations between OSAHS group and control group, and parameters of blood pressure, heart rate, blood oxygen saturation and serum inflammatory factor levels between control group and 3 OSAHS subgroups were observed and compared, and then correlations between grade of OSAHS severity with blood pressure variability and other risk factors were analyzed.Results There were significant differences in body mass index (BMI) and family history of OSAHS between OSAHS and control groups (P<0.05).There were significant differences in 24 h mean blood pressure, daytime average blood pressure, nighttime average blood pressure, descent rate of nighttime blood pressure, non dipper blood pressure rate, blood oxygen saturation, serum tumor necrosis factor-α (TNF-α), Interleukin-4 (IL-4), IL-6 and IL-8 between control group with 3 OSAHS subgroups (P<0.05).Values of 24h mean blood pressure, daytime average blood pressure, nighttime average blood pressure, non dipper blood pressure rate, serum TNF-α, IL-4, IL-6 and IL-8 levels in 3 OSAHS subgroups were significantly higher than those in control group (P<0.05), and the more severity of OSAHS in children, the higher values of 24h mean blood pressure, daytime average blood pressure, nighttime average blood pressure, non dipper blood pressure rate, serum TNF-α, IL-4, IL-6 and IL-8 levels they had, and the differences in the same index between each two groups among the 3 OSAHS subgroups were statistically significant (P<0.05).Descent rates of nighttime blood pressure in 3 OSAHS subgroups were significantly lower than that in control group (P<0.05), and the more severity of OSAHS in children, the lower descent rate of nighttime blood pressure the children had, and the differences in the rate between each two groups among 3 OSAHS subgroups were statistically significant (P<0.05).Level of blood oxygen saturation in severe OSAHS subgroup was significantly lower than those in control group, the mild OSAHS subgroup and moderate OSAHS subgroup (P<0.05).Covariance analysis showed that nighttime average blood pressure and non dipper blood pressure rate were positively correlated with OSAHS severity (P<0.05), while nocturnal blood pressure decreased rate was negatively correlated with OSAHS severity in children(P<0.05).Pearson correlation hierarchical analysis showed that BMI and serum levels of TNF-α, IL-4, IL-6 and IL-8 were positively correlated with OSAHS severity in children (P<0.05).Conclusion OSAHS in children is closely related with hypertension and serum inflammatory factors levels, and nighttime average blood pressure, non dipper blood pressure rate, BMI and serum TNF-α, IL-4, IL-6 and IL-8 are positively correlated with OSAHS severity, while nocturnal blood pressure decreased rate is negatively correlated with OSAHS severity.