持续气道正压通气治疗可改善合并阻塞性睡眠呼吸暂停的高血压患者血浆纤维蛋白凝块特性的改变。
Altered plasma fibrin clot properties in hypertensive patients with obstructive sleep apnoea are improved by continuous positive airway pressure treatment.
作者信息
Jóźwik-Plebanek Katarzyna, Prejbisz Aleksander, Wypasek Ewa, Pręgowska-Chwała Barbara, Hanus Katarzyna, Kaszuba Anna M, Januszewicz Magdalena, Bieleń Przemysław, Kabat Marek, Kruk Mariusz, Dobrowolski Piotr, Klisiewicz Anna, Śliwiński Paweł, Januszewicz Andrzej, Undas Anetta
机构信息
aDepartment of Hypertension, Institute of Cardiology, Warsaw bInstitute of Cardiology, Jagiellonian University Medical College cInnovative Laboratory Diagnostic Centre, John Paul II Hospital, Kraków dII Department of Radiology, Medical University of Warsaw e2nd Department of Respiratory Medicine, Institute of Tuberculosis and Lung Disease fDepartment of Coronary and Structural Heart Diseases, Institute of Cardiology gDepartment of Congenital Heart Diseases, Institute of Cardiology, Warsaw hCracow Centre for Medical Research and Technologies, John Paul II Hospital, Kraków, Poland.
出版信息
J Hypertens. 2017 May;35(5):1035-1043. doi: 10.1097/HJH.0000000000001269.
AIM
We investigated plasma fibrin clot properties in high-risk hypertensive patients with obstructive sleep apnoea (OSA) and assessed the impact of continuous positive airway pressure (CPAP) treatment on clot phenotype.
METHODS
We studied 50 hypertensive patients with clinically significant OSA (age 50.0 ± 8.8 years, 39 M, 11 F). In total, 38 hypertensive patients without OSA balanced for age, sex, blood pressure, cardiovascular risk factors, and metabolic status served as controls. Plasma fibrin clot properties, including clot permeability coefficient, clot lysis time (CLT), and turbidimetric parameters of clot formation were determined. Patients underwent transthoracic echocardiography, carotid ultrasonography, evaluation of endothelial function and calcium score index of coronary arteries, and Doppler imaging of renal arteries.
RESULTS
Compared with controls, OSA patients were characterized by more compact fibrin structure (lower median clot permeability coefficient, 6.00 vs. 7.25 10 cm; P < 0.001), impaired fibrinolysis (longer median CLT, 108.00 vs. 92.50 min; P < 0.001), and by faster clot formation (shorter median lag phase, 40.50 vs. 42.50 s; P = 0.041), and higher median maximum clot absorbency indicating denser fibrin networks (0.87 vs. 0.81; P = 0.028). Clot permeability coefficient and CLT correlated with apnoea-hypopnoea index (r = -0.46; P < 0.001 and r = 0.44; P < 0.001, respectively) as well with mean (r = 0.31; P = 0.003; r = -0.36; P = 0.001, respectively) and minimal oxygen saturation (r = 0.46; P < 0.001; r = -0.49; P < 0.001, respectively). After 3 months of CPAP treatment we observed an increase in clot permeability coefficient (5.95 vs. 7.60 10 cm; P = 0,001), shortened CLT (107.00 vs. 87.00; P = 0.006), a longer lag phase of fibrin formation (40.00 vs. 43.50 s; P = 0.013), and a trend toward lower maximum clot absorbency (0.86 vs. 0.81; P = 0.058).
CONCLUSION
In hypertensive patients at high cardiovascular risk, OSA was associated with unfavourable prothrombotic fibrin clot characteristics, including hypofibrinolysis, which significantly improve as early as after 3 months of CPAP treatment.
目的
我们研究了患有阻塞性睡眠呼吸暂停（OSA）的高危高血压患者的血浆纤维蛋白凝块特性，并评估了持续气道正压通气（CPAP）治疗对凝块表型的影响。
方法
我们研究了50例患有具有临床意义的OSA的高血压患者（年龄50.0±8.8岁，男性39例，女性11例）。总共38例无OSA的高血压患者作为对照，这些患者在年龄、性别、血压、心血管危险因素和代谢状态方面进行了平衡。测定了血浆纤维蛋白凝块特性，包括凝块渗透系数、凝块溶解时间（CLT）和凝块形成的比浊参数。患者接受了经胸超声心动图、颈动脉超声检查、内皮功能评估和冠状动脉钙化评分指数，以及肾动脉多普勒成像。
结果
与对照组相比，OSA患者的纤维蛋白结构更致密（中位凝块渗透系数更低，6.00对7.25×10⁻⁵cm；P<0.001），纤维蛋白溶解受损（中位CLT更长，108.00对92.50分钟；P<0.001），凝块形成更快（中位延迟期更短，40.50对42.50秒；P=0.041），中位最大凝块吸光度更高，表明纤维蛋白网络更致密（0.87对0.81；P=0.028）。凝块渗透系数和CLT与呼吸暂停低通气指数相关（r=-0.46；P<0.001和r=0.44；P<0.001），也与平均（r=0.31；P=0.??3；r=-0.36；P=0.001）和最低氧饱和度相关（r=0.46；P<0.001；r=-0.49；P<0.001）。CPAP治疗3个月后我们观察到凝块渗透系数增加（5.95对7.60×10⁻⁵cm；P=0.001），CLT缩短（107.00对87.00；P=0.006），纤维蛋白形成的延迟期更长（40.00对43.50秒；P=0.013），并且最大凝块吸光度有降低趋势（0.86对0.81；P=0.058）。
结论
在心血管风险高的高血压患者中，OSA与不利的促血栓形成纤维蛋白凝块特征相关，包括纤维蛋白溶解不足，而CPAP治疗3个月后这些特征即有显著改善。
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