王宇光，劉 佳，白云飛

兒童阻塞性睡眠呼吸暫停低通氣綜合征血壓變異性和血清中炎性因子表達(dá)水平及臨床意義

王宇光，劉 佳，白云飛

目的 探討兒童阻塞性睡眠呼吸暫停低通氣綜合征(obstructive sleep apnea-hypopnea syndrome， OSAHS)血壓變異性和血清中炎性因子表達(dá)水平及臨床意義。方法 選取2014年6月—2016年6月內(nèi)蒙古醫(yī)科大學(xué)第二附屬醫(yī)院收治的訴有睡眠打鼾及白天嗜睡等癥狀且符合兒童OSAHS診斷標(biāo)準(zhǔn)65例作為兒童OSAHS組，無上述癥狀常規(guī)體檢正常兒童22例作為正常對(duì)照組，兩組均進(jìn)行夜間多導(dǎo)睡眠監(jiān)測(cè)(polysomnography， PSG)。按疾病不同程度將65例兒童OSAHS分為輕度OSAHS組(27例)、中度OSAHS組(23例)和重度OSAHS組(15例)3組。觀察比較正常對(duì)照組和兒童OSAHS組一般資料，正常對(duì)照組與不同程度兒童OSAHS 3組各血壓參數(shù)、心率、血氧飽和度和血清炎性因子水平，并對(duì)兒童OSAHS嚴(yán)重程度與血壓變異性及其他各危險(xiǎn)因素的相關(guān)性進(jìn)行分析。結(jié)果 正常對(duì)照組與兒童OSAHS組體重指數(shù)及OSAHS家族史比較差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。正常對(duì)照組與不同程度兒童OSAHS 3組24 h平均血壓、白天平均血壓、夜間平均血壓、夜間血壓下降率、非勺型血壓率、血氧飽和度及血清腫瘤壞死因子(TNF)-α、白細(xì)胞介素(IL)-4、IL-6及IL-8水平總體比較差異均有統(tǒng)計(jì)學(xué)意義(P<0.05)。不同程度兒童OSAHS 3組24 h平均血壓、白天平均血壓、夜間平均血壓、非勺型血壓率及血清TNF-α、IL-4、IL-6、IL-8水平均高于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義(P<0.05)；且兒童OSAHS越嚴(yán)重24 h平均血壓、白天平均血壓、夜間平均血壓、非勺型血壓率及血清TNF-α、IL-4、IL-6、IL-8水平越高，不同程度兒童OSAHS 3組間同一指標(biāo)兩兩比較差異均有統(tǒng)計(jì)學(xué)意義(P<0.05)。夜間血壓下降率不同程度兒童OSAHS 3組均明顯低于正常對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義(P<0.05)；且兒童OSAHS越嚴(yán)重夜間血壓下降率越低，不同程度兒童OSAHS 3組間兩兩比較差異均有統(tǒng)計(jì)學(xué)意義(P<0.05)。血氧飽和度重度兒童OSAHS組明顯低于正常對(duì)照組、輕度兒童OSAHS組和中度兒童OSAHS組，差異均具有統(tǒng)計(jì)學(xué)意義(P<0.05)。協(xié)方差分析顯示夜間平均血壓、非勺型血壓率與兒童OSAHS嚴(yán)重程度呈正相關(guān)(P<0.05)，而夜間血壓下降率與兒童OSAHS嚴(yán)重程度呈負(fù)相關(guān)(P<0.05)。Pearson相關(guān)分層分析顯示，體重指數(shù)及血清TNF-α、IL-4、IL-6、IL-8水平與兒童OSAHS嚴(yán)重程度呈正相關(guān)(P<0.05)。結(jié)論 兒童OSAHS和高血壓、血清炎性因子水平密切相關(guān)，夜間平均血壓、非勺型血壓率、體重指數(shù)及血清TNF-α、IL-4、IL-6、IL-8水平與兒童OSAHS嚴(yán)重程度呈正相關(guān)，而夜間血壓下降率與兒童OSAHS嚴(yán)重程度呈負(fù)相關(guān)。

睡眠呼吸暫停,阻塞性；兒童;高血壓；炎性因子

兒童阻塞性睡眠呼吸暫停低通氣綜合征(obstructive sleep apnea-hypopnea syndrome， OSAHS)是一種臨床常見疾病，臨床主要表現(xiàn)為睡眠打鼾及張口呼吸等，嚴(yán)重?cái)_亂兒童正常通氣、睡眠結(jié)構(gòu)和面部發(fā)育[1]。兒童OSAHS最常見病因是腺樣體肥大，肥大增生的腺樣體易反復(fù)發(fā)生炎癥，從而引起一系列細(xì)胞因子及炎性介質(zhì)水平改變[2]。有研究表明OSAHS是引起高血壓的獨(dú)立危險(xiǎn)因素，高達(dá)50%的OSAHS患者合并高血壓病[3]。值得注意的是，目前臨床上兒童OSAHS與高血壓關(guān)系的研究較少，且現(xiàn)有結(jié)論仍有爭(zhēng)議[4-6]。本研究通過比較兒童OSAHS患兒和正常兒童24 h血壓變異性及血清炎性因子腫瘤壞死因子(tumor necrosis factor， TNF)-α、白細(xì)胞介素(IL)-4、IL-6、IL-8、C反應(yīng)蛋白(CRP)水平，探討兒童OSAHS血壓變異性和血清中炎性因子表達(dá)水平及臨床意義。

1 對(duì)象與方法

1.1 研究對(duì)象 選取2014年6月—2016年6月內(nèi)蒙古醫(yī)科大學(xué)第二附屬醫(yī)院收治的訴有睡眠打鼾及白天嗜睡等癥狀且符合兒童OSAHS診斷標(biāo)準(zhǔn)[7]65例作為兒童OSAHS組，無上述癥狀且常規(guī)體檢正常兒童22例作為正常對(duì)照組，兩組均進(jìn)行夜間多導(dǎo)睡眠監(jiān)測(cè)(polysomnography， PSG)。排除1周內(nèi)有上呼吸道感染及過敏等患兒以及有先天性心肺疾病患兒。按疾病不同程度將65例兒童OSAHS分為輕度OSAHS組(27例)、中度OSAHS組(23例)和重度OSAHS組(15例)3組。

1.2 觀察指標(biāo) 觀察比較正常對(duì)照組和兒童OSAHS組一般資料，正常對(duì)照組與不同程度兒童OSAHS 3組各血壓參數(shù)、心率、血氧飽和度和血清炎性因子水平，并對(duì)兒童OSAHS嚴(yán)重程度與血壓變異性及其他各危險(xiǎn)因素的相關(guān)性進(jìn)行分析。

1.3 方法

1.3.1 PSG監(jiān)測(cè)：所有兒童均采用美國德邦PSG系統(tǒng)進(jìn)行整夜7 h連續(xù)PSG監(jiān)測(cè)，記錄呼吸暫停低通氣指數(shù)(AHI)及血氧飽和度。AHI≥5及最低血氧飽和度<0.92時(shí)診斷為OSAHS[7]。根據(jù)AHI確定兒童OSAHS嚴(yán)重程度[7]：AHI 5～20為輕度，AHI 20～40為中度，AHI≥40為重度。

1.3.2 血壓監(jiān)測(cè)：所有兒童均采用多功能監(jiān)護(hù)儀進(jìn)行血壓監(jiān)測(cè)，24 h內(nèi)每30 min測(cè)定1次血壓，包括收縮壓(SBP)、舒張壓(DBP)及脈壓，測(cè)量期間避免劇烈運(yùn)動(dòng)。24 h平均血壓、白天平均血壓、夜間平均血壓=血壓值之和/測(cè)量次數(shù)；夜間血壓下降率=(白天平均血壓-夜間平均血壓)/白天平均血壓×100%，其值≥10%為血壓晝夜節(jié)律正常(即勺型血壓)，而<10%為血壓晝夜節(jié)律減弱或消失(即非勺型血壓)。

1.3.3 TNF-α、IL-4、IL-6、IL-8及CRP測(cè)定：所有兒童均晨起抽取空腹靜脈血5 ml，置于離心管中2000 r/min離心15 min，取上層血清。采用酶聯(lián)免疫吸附試驗(yàn)(ELISA)法測(cè)定血清中TNF-α、IL-4、IL-6、IL-8、CRP水平，ELISA試劑盒購自南京森倍加生物公司，嚴(yán)格按照試劑盒說明書進(jìn)行操作。

2 結(jié)果

2.1 正常對(duì)照組和兒童OSAHS組一般資料比較 正常對(duì)照組與兒童OSAHS組性別、年齡、身高和肥胖率比較差異無統(tǒng)計(jì)學(xué)意義(P>0.05)；而體重指數(shù)及OSAHS家族史比較差異有統(tǒng)計(jì)學(xué)意義(P<0.05)，見表1。

表1 正常對(duì)照組與兒童OSAHS組一般資料比較，例(%)]

注：OSAHS 為阻塞性睡眠呼吸暫停低通氣綜合征

2.2 正常對(duì)照組與不同程度兒童OSAHS 3組血壓、心率及血氧飽和度比較 正常對(duì)照組與不同程度兒童OSAHS 3組24 h平均血壓、白天平均血壓、夜間平均血壓、夜間血壓下降率、非勺型血壓率及血氧飽和度總體比較差異均有統(tǒng)計(jì)學(xué)意義(P<0.05)。不同程度兒童OSAHS 3組24 h平均血壓、白天平均血壓、夜間平均血壓、非勺型血壓率均明顯高于正常對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義(P<0.05)；且兒童OSAHS越嚴(yán)重24 h平均血壓、白天平均血壓、夜間平均血壓、非勺型血壓率越高，不同程度兒童OSAHS 3組間同一指標(biāo)兩兩比較差異均有統(tǒng)計(jì)學(xué)意義(P<0.05)。夜間血壓下降率不同程度兒童OSAHS 3組均明顯小于正常對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義(P<0.05)；且兒童OSAHS越嚴(yán)重夜間血壓下降率越低，不同程度兒童OSAHS 3組間兩兩比較差異均有統(tǒng)計(jì)學(xué)意義(P<0.05)。血氧飽和度重度兒童OSAHS組明顯低于正常對(duì)照組、輕度兒童OSAHS組和中度兒童OSAHS組，差異均具有統(tǒng)計(jì)學(xué)意義(P<0.05)；正常對(duì)照組、輕度兒童OSAHS組和中度兒童OSAHS組3組間兩兩比較差異均無統(tǒng)計(jì)學(xué)意義(P>0.05)。 見表2。

表2 正常對(duì)照組與不同程度兒童OSAHS 3組血壓、心率及血氧飽和度比較±s，例(%)]

注：OSAHS為阻塞性睡眠呼吸暫停低通氣綜合征；與正常對(duì)照組比較，aP<0.05；與輕度兒童OSAHS組比較，cP<0.05；與中度兒童OSAHS組比較，eP<0.05

2.3 正常對(duì)照組與不同程度兒童OSAHS 3組血清炎性因子水平比較 正常對(duì)照組與不同程度兒童OSAHS 3組血清TNF-α、IL-4、IL-6及IL-8水平總體比較差異均有統(tǒng)計(jì)學(xué)意義(P<0.05)。不同程度兒童OSAHS 3組血清TNF-α、IL-4、IL-6及IL-8水平均明顯高于正常對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義(P<0.05)；且兒童OSAHS越嚴(yán)重血清TNF-α、IL-4、IL-6及IL-8水平越高，不同程度兒童OSAHS 3組間同一指標(biāo)兩兩比較差異均有統(tǒng)計(jì)學(xué)意義(P<0.05)。見表3。

表3 正常對(duì)照組與不同程度兒童OSAHS 3組血清炎性因子水平比較±s)

注：OSAHS 為阻塞性睡眠呼吸暫停低通氣綜合征；與正常對(duì)照組比較，aP<0.05；與輕度兒童OSAHS組比較，cP<0.05；與中度兒童OSAHS組比較，eP<0.05

2.4 兒童OSAHS嚴(yán)重程度與血壓變異性及其他各危險(xiǎn)因素的相關(guān)性分析 協(xié)方差分析顯示夜間平均血壓、非勺型血壓率與兒童OSAHS嚴(yán)重程度呈正相關(guān)(P<0.05)，而夜間血壓下降率與兒童OSAHS嚴(yán)重程度呈負(fù)相關(guān)(P<0.05)，見表4。Pearson相關(guān)分層分析顯示，體重指數(shù)及血清TNF-α、IL-4、IL-6、IL-8水平與兒童OSAHS嚴(yán)重程度呈正相關(guān)(P<0.05)，見表5。

表4 兒童OSAHS嚴(yán)重程度與血壓變異性的相關(guān)性分析

注：OSAHS 為阻塞性睡眠呼吸暫停低通氣綜合征

表5 兒童OSAHS嚴(yán)重程度與其他各危險(xiǎn)因素的相關(guān)性分析

注：OSAHS 為阻塞性睡眠呼吸暫停低通氣綜合征

3 討論

OSAHS是一種以反復(fù)高碳酸血癥和低氧血癥為病理改變并造成多個(gè)系統(tǒng)功能損害的臨床綜合征。OSAHS在兒童中發(fā)病率為1.2%～5.7%，嚴(yán)重影響兒童身心發(fā)展[8-10]。

正常人群因受生理活動(dòng)和睡眠影響，24 h內(nèi)血壓值并非一成不變，而是日間高夜間低，夜間血壓較日間約下降10%～15%，呈典型的勺狀分布，這種血壓變異模式對(duì)維持正常生理活動(dòng)有重要的作用[11]。Garcia Rio等[12]發(fā)現(xiàn)OSAHS患者慢性缺氧和二氧化碳潴留狀態(tài)可引起肺動(dòng)脈高壓、交感神經(jīng)興奮，從而導(dǎo)致高血壓。Feres等[13]發(fā)現(xiàn)OSAHS患者血、尿兒茶酚胺含量無論在白天還是夜間均顯著高于正常者，證實(shí)了OSAHS通過興奮交感神經(jīng)致高血壓；后期進(jìn)一步通過24 h動(dòng)態(tài)血壓監(jiān)測(cè)發(fā)現(xiàn)，OSAHS患者早期主要表現(xiàn)為夜間動(dòng)脈血壓升高，重度OSAHS患者則全天血壓增高。Weiss等[14]明確指出OSAHS患者24 h血壓呈淺勺型模式，甚至?xí)円棺兓?jié)律消失。本研究發(fā)現(xiàn)兒童OSAHS血壓變異性類似于成人OSAHS，夜間血壓變異率減小或消失，呈非勺型血壓，且與兒童OSAHS嚴(yán)重程度呈負(fù)相關(guān)。另外，本研究發(fā)現(xiàn)兒童OSAHS舒張壓非勺型發(fā)生率較收縮壓高，這與Lee和Jeong[15]發(fā)現(xiàn)OSAHS患者舒張期高血壓的結(jié)果一致。非勺型高血壓與普通高血壓相比具有隱匿性，不宜早期發(fā)現(xiàn)，當(dāng)OSAHS患者出現(xiàn)日間高血壓時(shí)疾病大多已發(fā)展至重度。另外，有研究顯示非勺型高血壓較普通高血壓對(duì)心臟功能影響更大，Ermis等[16]發(fā)現(xiàn)非勺型高血壓患者病死率是勺型高血壓患者的4～5倍。因此，兒童OSAHS治療對(duì)兒童高血壓和血壓夜間變異改善有著重要意義。既往也有研究表明口腔矯正器對(duì)兒童OSAHS療效顯著[17]。

兒童OSAHS最常見的病因是腺樣體肥大，腺樣體是咽部淋巴環(huán)(Waldeyer環(huán))的重要組成部分，具有阻擋致病菌并釋放炎性因子的免疫功能，有研究表明缺氧狀態(tài)刺激腺樣體產(chǎn)生炎性因子[18]。本研究結(jié)果顯示，正常對(duì)照組與不同程度兒童OSAHS 3組血清TNF-α、IL-4、IL-6及IL-8水平總體比較差異均有統(tǒng)計(jì)學(xué)意義，而血清CRP水平總體比較差異無統(tǒng)計(jì)學(xué)意義；不同程度兒童OSAHS 3組血清TNF-α、IL-4、IL-6及IL-8水平均明顯高于正常對(duì)照組，且兒童OSAHS越嚴(yán)重血清TNF-α、IL-4、IL-6及IL-8水平越高；Pearson相關(guān)分層分析顯示，體重指數(shù)及血清TNF-α、IL-4、IL-6、IL-8水平與兒童OSAHS嚴(yán)重程度呈正相關(guān)，而血清CRP水平與兒童OSAHS嚴(yán)重程度無相關(guān)性。分析其可能的原因是CRP是一種急性期炎性指標(biāo)，對(duì)如OSAHS之類的慢性炎癥不敏感。TNF-α是一種具有多種生物學(xué)功能的細(xì)胞因子，參與輔助性T淋巴細(xì)胞(Th)1細(xì)胞免疫反應(yīng)，激活NF-κB，誘導(dǎo)細(xì)胞凋亡。Zhong等[19]研究發(fā)現(xiàn)中重度兒童腺樣體肥大組血清TNF-α水平較健康對(duì)照組明顯增加。而IL-4則是主要參與Th2細(xì)胞免疫反應(yīng)的炎性因子，且IL-4促進(jìn)B細(xì)胞增殖參與體液免疫。Anderson等[20]發(fā)現(xiàn)兒童OSAHS患兒血清IL-4水平較高。IL-6促進(jìn)T細(xì)胞和炎性細(xì)胞釋放多種促炎細(xì)胞因子，加重局部炎癥反應(yīng)。Martinez等[21]研究發(fā)現(xiàn)與正常對(duì)照患者相比OSAHS患者血清IL-6升高。IL-8的主要功能是趨化炎性細(xì)胞向損傷部位聚集，有學(xué)者發(fā)現(xiàn)OSAHS患者血清IL-8水平也升高[22]。既往研究和本研究結(jié)果說明炎性因子參與OSAHS患者一系列病理生理改變，血清炎性因子測(cè)定可以輔助判斷兒童OSAHS病情嚴(yán)重程度[23]。

綜上所述，本研究證實(shí)兒童OSAHS和高血壓、血清炎性因子水平密切相關(guān)，夜間平均血壓、非勺型血壓率、體重指數(shù)及血清TNF-α、IL-4、IL-6、IL-8水平與兒童OSAHS嚴(yán)重程度呈正相關(guān)，而夜間血壓下降率與兒童OSAHS嚴(yán)重程度呈負(fù)相關(guān)。提示血壓變異性和血清炎性因子水平可作為判斷兒童OSAHS治療效果的重要指標(biāo)。

[1] Marcus C L, Brooks L J, Draper K A,etal. Diagnosis and management of childhood obstructive sleep apnea syndrome[J].Pediatrics， 2012,130(3):714-755

[2] Musiatowiwcz M, Koda M, Sulkowski S. The TIMP-1 expression in germinal centers of hypertrophied adenoids in children[J].Int J Pediatr Otorhinolaryngol, 2013,77(3):384-388.

[3] Wang Y, Yang Q, Feng J,etal. The prevalence and clinical features of hypertension in patients with obstructive sleep apnea hypopnea syndrome and related nursing strategies[J].J Nurs Res, 2016,24(1): 41-47.

[4] 王燕,姜艷蕊,孫莞綺，等.兒童阻塞性睡眠呼吸暫停低通氣綜合征與血壓相關(guān)性研究[J].中國循證兒科雜志,2014,9(3):161-166.

[5] Archbold K H, Vasquez M M, Goodwin J L,etal. Effects of sleep patterns and obesity on increases in blood pressure in a 5-year period: report from the Tucson Children's Assessment of Sleep Apnea Study[J].J Pediatr, 2012,161(1):26- 30.

[6] Zintzaras E, Kaditis A G. Sleep-disordered breathing and blood pressure in children: a meta-analysis[J].Arch Pediatr Adolesc Med, 2007,161(2):172-178.

[7] 作者不詳.兒童阻塞性睡眠呼吸暫停低通氣綜合征診療指南草案(烏魯木齊)[J].中華耳鼻咽喉頭頸外科雜志,2007,42(2):83-84.

[8] Hunter S J, Gozal D, Smith D L,etal. Effect of sleep-disordered breathing severity on cognitive performance measures in a large community cohort of young school-aged children[J].Am J Respir Crit Care Med, 2016，194(6):739-747.

[9] Bixler E O, Fernandez Mendoza J, Liao D,etal. Natural history of sleep disordered breathing in prepubertal children transitioning to adolescence[J].Eur Respir J， 2016，47(5):1402-1409.

[10]Li A M, So H K, Au C T,etal. Epidemiology of obstructive sleep apnoea syndrome in Chinese children: a two-phase community study[J].Thorax, 2010,65(11): 991- 997.

[11]李慧妍,劉越.血壓變異性與靶器官損害關(guān)系的研究進(jìn)展[J].中國急救醫(yī)學(xué),2016,36(8):758-762.

[12]Garcia Rio F, Racionero M A, Pino J M,etal. Sleep apnea and hypertension[J].Chest, 2000,117(5):1417-1425.

[13]Feres M C, Cintra F D, Rizzi C F,etal. Evaluation and validation of a method for determining platelet catecholamine in patients withobstructive sleep apnea and arterial hypertension[J].PLoS One, 2014,9(6):98407.

[14]Weiss J W, Tamisier R, Liu Y. Sympathoexcitation and arterial hypertension associated with obstructive sleep apnea and cyclic intermittent hypoxia[J].J Appl Physiol (1985), 2015,119(12):1449-1454.

[15]Lee Y J, Jeong D U. Obstructive sleep apnea syndrome is associated with higher diastolic blood pressure in men but not in women[J].Am J Hypertens, 2014,27(3):325-330.

[16]Ermis N, Otlu Y O, Afsin A,etal. Comparison of left atrial volume and function in non-dipper versus dipper hypertensives: A real-time three-dimensional echocardiography study[J].Anatol J Cardiol, 2016,16(6):428-433.

[17]Lettieri C J, Paolino N, Eliasson A H,etal. Comparison of adjustable and fixed oral appliances for the treatment of obstructive sleep apnea[J].J Clin Sleep Medici, 2011,7(5):439-445.

[18]Ryan S, Taylor C T, McNicholas W T. Selective activation of inflammatory pathways by intermittent hypoxia in obstructive sleep apnea sydrome[J].Circulation, 2005,112(7):2660-2667.

[19]Zhong A, Xiong X, Xu H,etal. An updated meta-analysis of the association between tumor necrosis factor-α -308G/Apolymorphism and obstructive sleep apnea-hypopnea syndrome[J].Plos One, 2014,9(9):106270.

[20]Anderson M E Jr, Buchwald Z S, Ko J,etal. Patients with pediatric obstructive sleep apnea show altered T-Cell populations with a dominant TH17 profile[J].Otolaryngol Head Neck Surg, 2014,150(5):880-886.

[21]Martinez Ceron E, Barquiel B, Bezos A M,etal. Effect of continuous positive airway pressure on glycemic control in patients with obstructive sleep apnea and type 2 diabetes a randomized clinical trial[J].Am J Respir Crit Care Med, 2016,194(4):476-485.

[22]Zychowski K E, Sanchez B, Pedrosa R P,etal. Serum from obstructive sleep apnea patients induces inflammatory responses in coronary artery endothelial cells[J].Atherosclerosis, 2016,254:59-66.

[23]de Lima F F, Mazzotti D R, Tufik S,etal. The role inflammatory response genes in obstructive sleep apnea syndrome: a review[J].Sleep Breath, 2016,20(1):331-338.

Blood Pressure Variability and Expressions and Clinical Significances of Serum Inflammatory Factors in Children with Obstructive Sleep Apnea Hypopnea Syndrome

WANG Yu-guang1, LIU Jia2a, BAI Yun-fei2b

(1. Department of Medical Imaging, the Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010030, China; a. Department of Stomatology, b. Department of Otolaryngology, 2. Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China)

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.

Sleep apnea, obstructive; Children; Hypertension; Inflammatory factors

內(nèi)蒙古自治區(qū)衛(wèi)生和計(jì)劃生育委員會(huì)科研項(xiàng)目(201303049)

010030 呼和浩特，內(nèi)蒙古醫(yī)科大學(xué)第二附屬醫(yī)院影像科(王宇光)；010050 呼和浩特，內(nèi)蒙古醫(yī)科大學(xué)附屬醫(yī)院口腔科(劉佳)，耳鼻喉科(白云飛)

劉佳，電話：13674835551；E-mail：liujiababy@aliyun.com

R563.8

A

1002-3429(2017)08-0070-06

10.3969/j.issn.1002-3429.2017.08.022

2017-06-05 修回時(shí)間：2017-07-02)