增强型体外反搏治疗对老年高血压合并阻塞型睡眠呼吸暂停低通气综合征患者的疗效
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摘要
目的研究增强型体外反搏治疗(EECP)对老年高血压合并阻塞型睡眠呼吸暂停低通气综合征(OSAHS)患者血清超敏C反应蛋白(hs-CRP)水平、血清视黄醇结合蛋白4(RBP4)水平、踝肱指数(ABI)的影响。方法选取2017年8月至2018年3月于周口市中心医院住院的245例老年高血压合并OSAHS患者,采用随机数表法分为观察组(122例)和对照组(123例)。所有患者均接受苯磺酸氨氯地平片及无创正压通气治疗,观察组患者接受EECP治疗,共治疗72 h。观察两组患者血清hs-CRP水平、血清RBP4水平、ABI的变化,随访并记录治疗6个月后患者血压、心绞痛、头痛、头晕情况。结果两组患者治疗36、72 h后血清hs-CRP水平均较治疗前下降,两组患者治疗72 h后血清hs-CRP水平均低于治疗36 h后,差异有统计学意义(均P<0.05);观察组患者治疗72 h后血清RBP4水平较治疗前和治疗36 h后均下降,ABI较治疗前和治疗36 h后均变大,差异有统计学意义(均P<0.05)。治疗72 h后,观察组患者血清hs-CRP水平低于对照组,差异有统计学意义(P<0.05)。随访6个月,观察组患者血压下降幅度>20%者占45.9%(45/122),对照组占33.3%(41/123),两组数据相比,差异无统计学意义(P>0.05)。观察组心绞痛发生率为16%(19/122),对照组为32%(39/123),观察组心绞痛发生率低于对照组,差异有统计学意义(P<0.05)。观察组头晕头痛发生率为8%(10/122),对照组为43%(53/123),观察组头晕头痛发生率低于对照组,差异有统计学意义(P<0.001)。结论 EECP治疗可有效降低老年高血压合并OASHS患者血清hs-CRP、RBP4水平,提高ABI,可能具有减轻动脉粥样硬化进程、保护肾功能的作用,有望改善患者预后。
Objective To investigate the effect of enhanced external counterpulsation(EECP) on the serum level of high-sensitivity C-reactive protein(hs-CRP) and retinol binding protein 4(RBP4) and ankle brachial index(ABI) in elderly patients with hypertension complicated with obstructive sleep apnea-hypopnea syndrome(OSAHS).Methods A total of 245 elderly patients with hypertension and OSAHS admitted to Zhoukou Central Hospital from August of 2017 to March of 2018 were enrolled in observation group(122 cases) and control group(123 cases). All patients received amlodipine besylate tablets and non-invasive positive pressure ventilation. Patients in observation group received EECP for 72 h. Serum level of hs-CRP and RBP4 and ABI were observed in two groups. The blood pressure, angina pectoris, headache, and dizziness were followed up and recorded after 6 months of treatment.Results In the two groups, Serum level of hs-CRP decreased after 36 and 72 h of treatment, and serum level of hs-CRP after 72 h of treatment was lower than that after 36 h. In observation group, serum level of RBP4 after 72 h of treatmen was lower than that before treatment and 36 h after treatment, and ABI was larger than that before treatment and 36 h after treatment. All of above differences were statistically significant(all P<0.05). After 72 h of treatment, the serum level of hs-CRP in observation group was lower than that in control group, and the difference was statistically significant(P<0.05). During 6 months of follow-up of, patients whose decreasing amplitude of blood pressure >20% accounted for 45.9%(45/122) in observation group, and those accounted for 33.3%(41/123) in control group. There was no significant difference between the two groups(P>0.05). The incidence of angina pectoris was 16%(19/122) in observation group and 32%(39/123) in control group. The incidence of angina pectoris was lower in observation group than in control group(P<0.05). The incidence of dizziness and headache was 8%(10/122) in observation group and 43%(53/123) in control group. The incidence of dizziness and headache in observation group was lower than that in control group, and the difference was statistically significant(P<0.001).Conclusion EECP can effectively reduce serum level of hs-CRP and RBP4 and improve ABI in elderly patients with hypertension and OASHS. EECP may reduce the atherosclerosis process and protect renal function, and may improve the prognosis of patients.
Objective To investigate the effect of enhanced external counterpulsation(EECP) on the serum level of high-sensitivity C-reactive protein(hs-CRP) and retinol binding protein 4(RBP4) and ankle brachial index(ABI) in elderly patients with hypertension complicated with obstructive sleep apnea-hypopnea syndrome(OSAHS).Methods A total of 245 elderly patients with hypertension and OSAHS admitted to Zhoukou Central Hospital from August of 2017 to March of 2018 were enrolled in observation group(122 cases) and control group(123 cases). All patients received amlodipine besylate tablets and non-invasive positive pressure ventilation. Patients in observation group received EECP for 72 h. Serum level of hs-CRP and RBP4 and ABI were observed in two groups. The blood pressure, angina pectoris, headache, and dizziness were followed up and recorded after 6 months of treatment.Results In the two groups, Serum level of hs-CRP decreased after 36 and 72 h of treatment, and serum level of hs-CRP after 72 h of treatment was lower than that after 36 h. In observation group, serum level of RBP4 after 72 h of treatmen was lower than that before treatment and 36 h after treatment, and ABI was larger than that before treatment and 36 h after treatment. All of above differences were statistically significant(all P<0.05). After 72 h of treatment, the serum level of hs-CRP in observation group was lower than that in control group, and the difference was statistically significant(P<0.05). During 6 months of follow-up of, patients whose decreasing amplitude of blood pressure >20% accounted for 45.9%(45/122) in observation group, and those accounted for 33.3%(41/123) in control group. There was no significant difference between the two groups(P>0.05). The incidence of angina pectoris was 16%(19/122) in observation group and 32%(39/123) in control group. The incidence of angina pectoris was lower in observation group than in control group(P<0.05). The incidence of dizziness and headache was 8%(10/122) in observation group and 43%(53/123) in control group. The incidence of dizziness and headache in observation group was lower than that in control group, and the difference was statistically significant(P<0.001).Conclusion EECP can effectively reduce serum level of hs-CRP and RBP4 and improve ABI in elderly patients with hypertension and OASHS. EECP may reduce the atherosclerosis process and protect renal function, and may improve the prognosis of patients.
引文
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[8] 朱凌波, 洪小苏, 陈芳, 等. 踝臂指数、脉搏波传导速度对冠心病的预测价值[J]. 江苏医药, 2008, 34(7): 677-679.
[9] 郑直, 林培森, 石洪, 等. 增强型体外反搏对高血压合并不稳定型心绞痛患者血管内皮功能及血栓素A2与前列环素比值的影响[J]. 中华高血压杂志, 2016, 24(2): 177-180.
[10] 周国强, 黄宗青, 肖剑伟, 等. 增强型体外反搏对缺血性卒中患者动脉弹性的影响[J]. 中国神经精神疾病杂志, 2014, 7(40): 385-389.
[11] 中国高血压防治指南修订委员会. 中国高血压防治指南2010[J]. 中华心血管病杂志, 2011, 39(7): 579-616.
[12] 中华医学会呼吸病学分会睡眠呼吸障碍学组. 阻塞性睡眠呼吸暂停低通气综合征诊治指南(2011年修订版)[J]. 中华结核和呼吸杂志, 2012, 35(1): 9-12.
[13] BUDHIRAJA R, PARTHASARATHY S, QUAN S F. Endothelial dysfunction in obstructive sleep apnea[J]. J Clin Sleep Med, 2007, 3(4): 409-415.
[14] CHEN Y, LI Y, JIANG Q, et al. Analysis of early kidney injury-related factors in patients with hypertension and obstructive sleep apnea hypopnea syndrome (OSAHS)[J]. Arch Iran Med, 2015, 18(12): 827-833.
[15] GILES T D. Assessment of global risk: a foundation for a new, better definition of hypertension[J]. J Clin Hypertens (Greenwich), 2006, 8(Suppl 2): 5-14.
[16] CASEY D P, BECK D T, NICHOLS W W, et al. Effects of en hanced external counterpulsation on arterial stiffness and myocardial oxygen demand in patients with chronic angina pectoris[J]. Am J Cardiol, 2011, 107(104): 1466-1472.
[17] 刘敏, 黄彩云. 联合检测同型半胱氨酸、胱抑素C与尿酸含量在早期糖尿病肾脏疾病诊断中的价值[J]. 贵州医药, 2016, 40(9): 977-979.
[18] 何佳, 宁会彬, 曾艳丽, 等. 血清中β2微球蛋白、视黄醇结合蛋白、胱抑素C在替诺福韦或恩替卡韦单药治疗慢性乙型肝炎早期肾功能变化的意义[J]. 中华肝脏病杂志, 2016, 24(9): 643-646.
[2] 肖丽茹, 刘仲华, 隋彩珍. 正压通气治疗睡眠呼吸暂停综合征并代谢综合征的研究[J]. 心血管康复医学杂志, 2008, 17(1): 59-61.
[3] YOUNG T, PEPPARD P E, GOTTLIEB D J. Epidemiology of obstructive sleep apnea: a population health perspective[J]. Am J Respir Crit Care Med, 2002, 165(9): 1227-1239.
[4] 王前, 郑磊, 曾方银. 超敏C-反应蛋白的研究现状及临床应用[J]. 中华检验医学杂志, 2004, 27(8): 542-544.
[5] 汪迎春, 李南方, 王新玲, 等. 高血压合并阻塞性睡眠呼吸暂停低通气综合征患者高敏C反应蛋白的研究[J]. 心血管康复医学杂志, 2011, 20(3): 217-220.
[6] 蒋伏松, 成兴波, 李慧娟, 等. 血清视黄醛结合蛋白4与2型糖尿病颈动脉粥样硬化的关系[J]. 苏州大学学报(医学版), 2009, 29(11): 508-510.
[7] 崔红权. 血清视黄醇结合蛋白与胱抑素C联合检测在肾脏疾病临床诊断中的价值分析[J]. 中国卫生检验杂志, 2017, 27(23): 3425-3427.
[8] 朱凌波, 洪小苏, 陈芳, 等. 踝臂指数、脉搏波传导速度对冠心病的预测价值[J]. 江苏医药, 2008, 34(7): 677-679.
[9] 郑直, 林培森, 石洪, 等. 增强型体外反搏对高血压合并不稳定型心绞痛患者血管内皮功能及血栓素A2与前列环素比值的影响[J]. 中华高血压杂志, 2016, 24(2): 177-180.
[10] 周国强, 黄宗青, 肖剑伟, 等. 增强型体外反搏对缺血性卒中患者动脉弹性的影响[J]. 中国神经精神疾病杂志, 2014, 7(40): 385-389.
[11] 中国高血压防治指南修订委员会. 中国高血压防治指南2010[J]. 中华心血管病杂志, 2011, 39(7): 579-616.
[12] 中华医学会呼吸病学分会睡眠呼吸障碍学组. 阻塞性睡眠呼吸暂停低通气综合征诊治指南(2011年修订版)[J]. 中华结核和呼吸杂志, 2012, 35(1): 9-12.
[13] BUDHIRAJA R, PARTHASARATHY S, QUAN S F. Endothelial dysfunction in obstructive sleep apnea[J]. J Clin Sleep Med, 2007, 3(4): 409-415.
[14] CHEN Y, LI Y, JIANG Q, et al. Analysis of early kidney injury-related factors in patients with hypertension and obstructive sleep apnea hypopnea syndrome (OSAHS)[J]. Arch Iran Med, 2015, 18(12): 827-833.
[15] GILES T D. Assessment of global risk: a foundation for a new, better definition of hypertension[J]. J Clin Hypertens (Greenwich), 2006, 8(Suppl 2): 5-14.
[16] CASEY D P, BECK D T, NICHOLS W W, et al. Effects of en hanced external counterpulsation on arterial stiffness and myocardial oxygen demand in patients with chronic angina pectoris[J]. Am J Cardiol, 2011, 107(104): 1466-1472.
[17] 刘敏, 黄彩云. 联合检测同型半胱氨酸、胱抑素C与尿酸含量在早期糖尿病肾脏疾病诊断中的价值[J]. 贵州医药, 2016, 40(9): 977-979.
[18] 何佳, 宁会彬, 曾艳丽, 等. 血清中β2微球蛋白、视黄醇结合蛋白、胱抑素C在替诺福韦或恩替卡韦单药治疗慢性乙型肝炎早期肾功能变化的意义[J]. 中华肝脏病杂志, 2016, 24(9): 643-646.