Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a disease marked by apnea, hypopnea, decreased oxygen saturation, and disordered sleep structure, which is a major risk for cardiovascular disease. Recent studies have found that OSAHS patients have an increased risk of hypertension, coronary atherosclerotic heart disease, insulin resistance, type 2 diabetes, metabolic syndrome, non-alcoholic fatty liver disease, etc. And these patients have a high prevalence of obvious glucolipid metabolism disorder (GMD) , which plays an important role in cardiovascular morbidity and mortality in OSAHS. We reviewed the latest advances in the association of GMD and OSAHS, and the potential pathogenesis of OSAHS-induced GMD and insulin resistance, aiming at providing new ideas for clinical treatment of GMD in OSAHS.

BackgroundThe prevalence of essential hypertension complicated with obstructive sleep apnea hypopnea syndrome (OSAHS) has been increasing year by year. However, due to the differences in medical conditions and lack of clinical understanding in different regions of China, the diagnosis of hypertension complicated with OSAHS is still insufficient. Relevant studies have shown that the pathogenesis of hypertension complicated with OSAHS is closely related to the ectopic accumulation of fat and insulin resistance.ObjectiveThis study attempted to analyze the relationship between OSAHS and abdominal visceral adipose tissue (VAT) and homeostasis model assessment of insulin resistance (HOMA-IR) , and their predictive value for hypertension complicated with OSAHS.MethodsTwo hundred and thirty-four patients with essential hypertension treated at hypertension center of Yan'an Hospital of Kunming Medical University from January 2019 to July 2020 were enrolled in the study. The HOMA-IR of the enrolled patients was calculated by polysomnography, VAT measurement, parallel glucose tolerance and insulin release experiments. According to the AHI level, 27 patients were divided into hypertension group (AHI<5 times/h) , and 207 patients were divided into hypertension complicated with OSAHS group (AHI≥5 times/h) . The levels of VAT and HOMA-IR were compared between 2 groups. The receiver operating characteristic (ROC) curve of screening hypertension patients complicated with OSAHS were determined by HOMA-IR and VAT, and the diagnosis value of area under AUC and different cut-off value were calculated. Logistic regression modeling was used to determine ROC curve with the saved probability as a separate variable to analyze the AUC of the two combined diagnosis of hypertension and OSAHS.ResultsThe VAT, HOMA-IR and BMI of hypertension complicated with OSAHS group were significantly higher than the hypertension group, while LSaO2 was significantly lower than the hypertension group. VAT, HOMA-IR and BMI were positively correlated with AHI (P<0.05) , and LSaO2 was negatively correlated with AHI (P<0.05) . The AUC of ROC curve for the diagnosis of hypertension complicated with OSAHS by VAT was 0.905 〔95%CI (0.861, 0.949) 〕, and the sensitivity and specificity were 0.763 and 0.926 when the diagnostic cut-off point was 100.5 cm2. The ROC curve AUC of HOMA-IR in the diagnosis of hypertension complicated with OSAHS was 0.813 〔95%CI (0.725, 0.900) 〕, when the diagnostic cut-off point was 2.015, the sensitivity and specificity were 0.797 and 0.778, respectively, and the AUC of ROC curve for combined factor diagnosis of hypertension complicated with OSAHS was 0.917 〔95%CI (0.871, 0.963) 〕, the diagnostic cut-off point was 2.045, the sensitivity and specificity were 0.831 and 0.963, respectively.ConclusionVAT and HOMA-IR in hypertension patients complicated with OSAHS are significantly higher than those in patients with hypertension. VAT and HOMA-IR have a certain predictive value for hypertension complicated with OSAHS, and can be applied to medical institutions that unconditionally carry out polysomnography, in order to intervene as early as possible to reduce the risk of serious complications of cardiovascular and cerebrovascular diseases.

目的:研究血清可溶性Klotho(sKlotho)水平与原发性高血压动脉硬化的相关性.方法:选取2017年1月-2018年12月在昆明医科大学附属延安医院就诊的196例初诊高血压患者(高血压组)和121例健康对照者(对照组),检测血清sKlotho、血脂、血糖、尿酸等常规生化指标,测定24 h尿钠排泄来计算估测摄盐量,同时检测臂踝脉搏波速度(baPWV)和颈动脉最大内膜中层厚度(IMT),研究血清sKlotho水平与高血压动脉弹性的关系.结果:高血压组血清sKlotho水平较对照组降低,而baPWV和Max IMT较对照组升高(均P＜0.05).高血压组估测摄盐量(10.51±4.19)g较对照组(8.97±3.48)g明显升高(P＜0.01).高血压组中,血清sKlotho水平与年龄、收缩压(SBP)、舒张压(DBP)、平均动脉压(MBP)、24 h尿钠呈负相关性,与估测肾小球滤过率(eG-FR)呈正相关性(均P＜0.01);高血压组baPWV和IMT与血清sKlotho水平呈负相关性(r=-0.59、-0.61,均P＜0.01).baPWV≥1400 cm/s和IMT≥1.0 mm的患者血清sKlotho显著降低(P＜0.05).多重logistic回归分析显示,年龄、吸烟、MBP、血脂异常、估测摄盐量是baPWV的危险因素,血清sKlotho是baPWV的保护因素(P=0.024,OR=0.86,95％CI:0.295～0.977).结论:高血压患者血清sKlotho水平较非高血压患者降低,与动脉硬化指标baPWV、IMT呈负相关性,是baPWV的保护因素,可作为动脉僵硬度的生物标志物.

目的:研究云南省佤族原发性高血压人群估测摄盐量与早期肾损害的关系.方法:选取2014年10月云南省临沧市耿马县四排山乡年龄≥18岁的佤族高血压患者260例(高血压组)和佤族非高血压患者286例(非高血压组).收集所有对象的年龄、性别、身高、体重、血压、腰围、臀围等基本信息.采集空腹静脉血测定空腹葡萄糖(GLU)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、肾功能、电解质等指标.收集点尿标本测定尿电解质、尿白蛋白、尿肌酐,通过点尿法估算24 h尿钠的排泄量.结果:高血压组和非高血压组间体重、BMI、腰围、臀围、收缩压、舒张压、尿酸、TG、血钠、尿钾、估测摄盐量、随机尿白蛋白/肌酐比值均差异有统计学意义(均P＜0.05).高血压组估测摄盐量较非高血压组明显升高,差异有统计学意义[(20.21±5.48) g∶(15.08±3.03)g;P＜0.05].在佤族高血压患者中,估测摄盐量和随机尿白蛋白/肌酐比值高度相关(r=0.89,P=0.000),BMI、腰臀比、收缩压、舒张压、GLU、TG、LDL-C、尿钠/尿钾与尿白蛋白/肌酐比值具有相关性(r=0.243、0.351、0.349、0.291、0.327、0.203、0.298、0.178,均P＜0.05).多元线性回归分析显示,年龄、估测摄盐量、收缩压、舒张压、BMI与尿白蛋白/肌酐比值相关,估测摄盐量是影响尿白蛋白/肌酐比值的独立危险因素.结论:佤族人群普遍估测摄盐量高,该人群估测摄盐量和随机尿白蛋白/肌酐比值高度相关,且是早期肾损害的独立危险因素.

目的:探讨血管紧张素转换酶(AC E2)基因多态性与佤族原发性高血压(EH)人群的关系.方法:应用SnapShot技术检测了260例云南佤族EH患者及290名正常血压对照者ACE2基因20个多态位点基因型(rs1514283、rs1514282、rs2074192、rs233575、rs714205、rs4240157、rs4646176、rs4646174、rs879922、rs4646156、rs4646155、rs4646188、rs4646140、rs2158083、rs2285666、rs2106809、rs1978124、rs6632677、rs2301692、rs2306193),应用x2检验比较组间基因型及等位基因频率,运用Hardy-Weinberg平衡检验后,用Haploview软件进行连锁不平衡分析,并用SHEsis软件进行单倍体构建,从而探讨ACE2基因多态性与佤族人群高血压的相关关系.结果:①本次研究在20个候选位点发现5个多态位点,这5个位点均存在连锁不平衡现象,但部分位点不能在以后的研究中相互代替.②rs2285666位点、rs714205位点的CC基因型及C等位基因是佤族女性EH的保护因素(P＜0.05,OR＜1),而rs2285666位点的T等位基因、rs714205位点的G等位基因是佤族女性EH患病的致病因素(P＜0.05,OR＞1);在佤族男性群体中并没有发现具有统计学意义的基因型及等位基因(P＞0.05).③对ACE2的5个多态性位点构建单倍型,未发现具有统计学意义的单倍型,说明这5个位点组成的单倍型与佤族EH均无关联.结论:ACE2基因中rs2285666及rs714205这两个多态位点可能与佤族女性EH相关.

Hypoxia inducible factors ( HIFs ) responds to the lipid metabolism disorder caused by fatty liver by regulating certain downstream gene expression .It also regulates liver lipid metabolism in the patients with obstructive sleep apnea .Obstructive sleep apnea and obesity synergistically accelerate tissue hypoxia ,which further leads to severe hepatic steatosis and inflammation .At present ,there are plenty of basic researches in worldwide ,which aiming at exploring HIFs plays a protective role or harmful effect in the development of fatty liver . Therefore clarifying the molecular mechanisms of HIFs regulating liver lipid metabolism will allow effective targeting of HIFs as novel thera -pies in fatty liver and some other related diseases .

Objective To explore the correlation between catechol-O-methyltransferase (COMT) gene polymorphism and the occurrence of senile hypertension with depression.Methods Ninety-eight Han inpatients with senile hypertension complicating depression(elderly hypertension complicating depression group) in our hospitals from January 2010 to July 2014 were selected and contemporaneous 100 Han cases of senile hypertension(elderly hypertension group) and 100 healthy Han elderly people(elderly control group) served as the study subjects.PCR-RFLP was employed to detect COMT gene 1947 locus polymorphism distribution frequency for conducting analysis.Results The genotype frequencies of AA and AG at COMT 1947 locus in the elderly hypertension complicating depression group were significantly higher than those in the elderly control group(28.57 ％,51.02 ％ vs.19.00 ％,39.00％,P＜0.01).The A allele frequency in the elderly hypertensive complicating depression group was significantly higher than that in the elderly control group(54.08％ vs.38.50％,P＜0.01).The risk of hypertension complicating depression occurrence in the population carrying A allele was 1.881 times that of carrying G allele(OR =1.881,95 ％ CI:1.261-2.807,P＜0.01).The various genotypes frequencies had no statistical difference between the elderly hypertension group and elderly hypertension complicating depression group(P＞0.05).However,the COMT 1947A/G allele frequencies had statistical difference between the two groups (P＜0.05).The A allele frequencies in the hypertension complicating depression group was 54.08％,which was higher than 42.50％ in the elderly hypertension group (P＜0.01),moreover the risk of depression occurrence in the population carrying A allele was 1.593 times that of carrying G allele(OR=1.593,95％CI:1.071-2.37,P＜0.01).Conclusion COMT gene polymorphism could have correlation with the occurrence of elderly hypertensive complicating depression.Detecting COMT 1947 locus genotype in elderly patients with hypertension can serve as an important indicator for predicting depression occurrence.

目的：探讨肱踝脉搏波传导速度（BaPWV ）和踝臂指数（ABI）与冠状动脉粥样硬化病变Gensini评分的相关性。方法对251例行冠状动脉造影的患者进行 Gensini评分。检测BaPWV 和 ABI ，并与冠状动脉 Gensini评分行相关性分析。结果随Gensini评分增高，BaPWV逐渐增高、ABI逐渐减小（P＜0．05）。BaPWV与冠状动脉Gensini评分呈正相关（P＜0．01）， ABI与Gensini评分呈负相关（P＜0．01）。结论 BaPWV与冠状动脉病变程度呈正相关，ABI与冠状动脉病变程度呈负相关。BaPWV和ABI对冠心病的早期识别、冠状动脉病变进展监测有显著价值。

目的 分析老年原发性高血压患者动态动脉硬化指数(AASI)与脉搏波传导速度(baPWV)、脉压指数(PPI)的关系,探讨这些指标在老年高血压患者动脉弹性评估中的意义.方法 选择昆明医科大学附属延安医院2014年5月至2015年2月门诊及住院治疗的老年原发性高血压患者89例,分别进行动态血压检测和无创动脉硬化检测,采用Spearman分析AASI与baPWV、PPI的相关性.结果 本组89例研究对象中baPWV为(1 603.41±19.84) cm/s,AASI为(0.61±0.15),PPI为(0.44±0.06).Spearman等级相关分析显示,AASI与平均舒张压呈负相关(r=-0.157,P＜O.05).baPWV、PPI、平均脉压、平均收缩压与AASI呈正相关(r=0.685、0.701、0.648、0.416,P＜O.01),且AASI与BaPWV、PPI的相关系数最高.结论 AASI可以反映动脉硬化的程度,随着AASI数值的增大,baPWV、PPI也随之增大.

目的：探讨颈动脉和足背动脉粥样硬化与冠状动脉粥样硬化病变Gensini评分的相关性。方法对270例行冠脉造影的患者进行Gensini积分评分。所有患者同时行血管超声检查，检测颈动脉IMT、粥样斑块面积、Crouse积分以及足背动脉IMT、血管内径、峰值流速，并与冠状动脉Gensini积分行相关性分析。结果（1）从Gensini积分0组到积分4组，颈动脉IMT、斑块面积、斑块Crouse积分和足背动脉IMT逐渐增高，足背动脉内径和峰值流速逐渐降低；（2）颈动脉IMT、斑块面积、斑块Crouse积分、足背动脉IMT与冠状动脉Gensini积分呈正相关（P＜0.01），足背动脉内径与冠状动脉Gensini积分呈负相关（P＜0.01）；（3）颈动脉IMT、斑块面积、斑块Crouse积分、足背动脉IMT以及足背动脉内径均为冠状动脉病变程度的独立相关因子。结论血管超声检查颈动脉和足背动脉粥样硬化与冠状动脉粥样硬化病变程度相关性较好，包括冠脉早期病变，通过外周血管超声检查可客观评估冠状动脉病变的进展情况，尤其可为早期冠状动脉粥样硬化病变人群的管理和干预提供可靠依据。

目的 探讨血浆同型半胱氨酸(homocysteine,Hcy)水平与冠状动脉病变程度及斑块稳定性的关系.方法 依据64层双源CT (dual-source computed tomography 64-DSCT)结果将120例冠心病患者以CT值不同分为易损斑块组、混合斑块组和硬斑块组,每组40例,同期选择冠状动脉CT正常的老年患者40例作为对照组.再根据冠脉病变情况将冠心病患者分为多支病变组、双支病变组、单支病变组.检查所有患者血浆Hcy水平,分析Hcy与斑块稳定性和冠脉病变支数的关系.结果 易损斑块组Hcy水平(19.32 ±4.76) μmol/L比混合斑块组(14.15± 3.89) μmol/L、硬斑块组(14.33±2.91) μmol/L和对照组(9.32±3.84) μmol/L高,差异有统计学意义,P＜0.05.Hcy水平在冠脉双支病变组(15.38±3.45) μmol/L、多支病变组(16.12±4.12) μmol/L均比单支病变组(10.45±2.76)μmol/L高,差异有统计学意义,P＜0.05.结论 Hcy水平可反映冠脉病变程度的严重性和斑块的稳定性.

目的：利用64层双源CT（64－DSCT）冠状动脉血管成像结合外周血管超声和炎性标志物分析老年糖尿病（DM）合并冠心病（CHD）患者冠状动脉、颈动脉、足背动脉病变特征及血清炎性标志物的变化特点和冠脉斑块的稳定性。方法选取2010年12月至2013年10月在昆明医科大学附属延安医院老年科和心内科住院，诊断明确为CHD患者129例，根据有无2型糖尿病（T2DM）病史分为老年 CHD组（n＝69）和老年 T2DM合并CHD组（n＝60）。经64－DSCT检查、颈动脉和足背动脉超声检查对比两组患者冠状动脉、颈动脉、足背动脉病变性质和血清炎性标志物的差异。结果64－DSCT显示老年T2DM合并CHD组冠脉病变以多支病变为主，与老年CHD组比较差异有统计学意义（P＜0．01）。老年T2DM合并 CHD与老年组比较斑块构成有差别，老年T2DM合并CHD组软斑所占比例比老年CHD组高（P＜0．05）。老年T2DM合并CHD组颈动脉和足背动脉超声斑块检出率均高于老年CHD组（P＜0．05）。老年T2DM合并CHD组颈动脉和足背动脉易损斑块的检出率高于老年CHD组（P＜0．05）。老年T2DM合并CHD组白细胞介素（IL）－6、血浆黏附分子（VCAM）1、基质金属蛋白酶（MMP）－9、同型半胱氨酸（Hcy）表达均高于老年CHD组（P＜0．05）。冠脉双支病变组和多支病变组外周血管斑块数较单支病变组多（P＜0．05）。结论老年DM合并CHD患者冠脉病变以多支血管病变为主，冠状动脉、颈动脉、足背动脉病变以易损斑块为主。颈动脉和足背动脉超声可以预测冠脉病变，外周血管斑块数越多，冠脉病变的支数越多。血清学标志物 IL－6、VCAM1、MMP－9、Hcy可作为预测斑块稳定性的指标。