外周血炎症指标在阻塞性睡眠呼吸暂停低通气综合征伴高血压中的临床意义

doi:10.6040/j.issn.1673-3770.0.2023.174

摘要/Abstract

摘要： 目的探讨阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome, OSAHS)伴高血压患者外周血炎症指标的变化,以辅助评估患者病情。方法回顾性分析经多导睡眠监测(polysomnography, PSG)确诊OSAHS患者196例。根据是否患有高血压将患者分为单纯OSAHS组(150例)及OSAHS伴高血压组(46例),计算以下炎症指标:中性粒细胞与淋巴细胞的比值(neutrophil-to-lymphocyte ratio, NLR),血小板与淋巴细胞的比值(platelet-to-lymphocyte ratio, PLR),单核细胞与淋巴细胞的比值(monocyte-to-lymphocyte ratio, MLR),全身免疫炎症指数(systemic immune-inflammation index, SII)。分析两组间临床基础指标、PSG参数及炎症指标的差异,并对炎症指标与血压值进行相关性分析,同时对血压值进行回归分析以探索危险因素。结果炎症指标方面,OSAHS伴高血压组患者NLR、PLR和SII水平均显著高于单纯OSAHS组患者,差异有统计学意义(P=0.007; P=0.032; P=0.009)。相关性分析提示,OSAHS患者收缩压与体质量指数(body mass index, BMI)、呼吸暂停低通气指数(apnea hypopnea index, AHI)、NLR及SII呈正相关(r=0.195, P=0.006; r=0.195, P=0.006; r=0.208, P=0.004; r=0.246, P=0.001),与睡眠最低氧饱和度(the lowest oxygen saturation, LSaO₂)呈负相关(r =-0.228, P=0.001),舒张压与BMI、AHI、NLR、SII呈正相关(r=0.160, P=0.025; r=0.210, P=0.003; r=0.145, P=0.043; r=0.206, P=0.004),与LSaO₂呈负相关(r=-0.203, P=0.004)。二元逻辑回归分析显示年龄及SII为OSAHS伴高血压患者的独立危险因素。分别将收缩压与舒张压作为因变量进行多元线性回归分析,结果显示低通气最长时间及SII是影响OSAHS患者血压的危险因素。结论 NLR及SII水平在OSAHS伴高血压患者中显著增高,且与血压值显著相关,临床监测上述指标有助于辅助评估患者病情。

关键词: 阻塞性睡眠呼吸暂停低通气综合征, 高血压, 中性粒细胞与淋巴细胞比值, 血小板与淋巴细胞比值, 单核细胞与淋巴细胞比值, 全身免疫炎症指数

Abstract: Objective To assist with evaluating the patient's condition, we investigated peripheral blood inflammatory marker changes in patients with obstructive sleep apnea hypopnea syndrome(OSAHS)complicated with hypertension. Methods We retrospectively analyzed data from 196 patients with OSAHS diagnosed by polysomnography(PSG). The patients were divided into the simple OSAHS(150 cases)or the OSAHS with hypertension(46 cases)groups. The following inflammatory indexes were calculated: neutrophil-to-lymphocyte ratio(NLR), platelet-to-lymphocyte ratio(PLR), monocyte-to-lymphocyte ratio(MLR), and the systemic immune-inflammation index(SII). The differences of the basic clinical data, PSG parameters, and inflammatory indexes were compared between the two groups. The inflammatory indexes and blood pressure were also correlated. Regression analysis of the variables associated with blood pressure was conducted. Results Considering the inflammatory markers, the NLR, PLR, and SII levels in patients with OSAHS and hypertension were significantly higher than those with only OSAHS(P=0.007; P=0.032; P=0.009). Correlation analysis showed that systolic blood pressure in patients with OSAHS was positively correlated with the body mass index(BMI), apnea-hypopnea index(AHI), NLR, and SII(r=0.195, P=0.006; r=0.195, P=0.006; r=0.208, P=0.004; r=0.246, P=0.001, respectively), and negatively correlated with the lowest oxygen saturation(LSaO₂; r=-0.228, P=0.001). The diastolic blood pressure in patients with OSAHS was also positively correlated with BMI, AHI, NLR, and SII(r=0.160, P=0.025; r=0.210, P=0.003; r=0.145, P=0.043; r=0.206, P=0.004, respectively), and negatively correlated with LSaO₂(r=-0.203, P=0.004). Binary logistic regression analysis showed that age and SII were independent risk factors for the patients with OSAHS and hypertension. Systolic blood pressure and diastolic blood pressure were considered in the multiple linear regression as dependent variables. The results suggest that the longest hypopnea time and SII were risk factors for blood pressure in patients with OSAHS. Conclusion NLR and SII significantly increased in patients with OSAHS and hypertension and were also significantly associated with blood pressure. Thus, clinical monitoring of the above indicators may assist in evaluating the patient's condition.

Key words: Obstructive sleep apnea hypopnea syndrome, Hypertension, Neutrophil-to-lymphocyte ratio, Platelet-to-lymphocyte ratio, Monocyte-to-lymphocyte ratio, The systemic immune-inflammation index

中图分类号:

R766.4

袁钰淇,曹子讷,牛晓欣,谢雨杉,苏永龙,朱思敏,张一彤,刘海琴,任晓勇,施叶雯. 外周血炎症指标在阻塞性睡眠呼吸暂停低通气综合征伴高血压中的临床意义[J]. 山东大学耳鼻喉眼学报, 2023, 37(6): 85-92.

YUAN Yuqi, CAO Zine, NIU Xiaoxin, XIE Yushan, SU Yonglong, ZHU Simin, ZHANG Yitong, LIU Haiqin, REN Xiaoyong, SHI Yewen. Clinical significance of peripheral blood inflammatory markers in obstructive sleep apnea hypopnea syndrome with hypertension[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(6): 85-92.

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