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目的 :探讨阻塞性睡眠呼吸暂停综合征 (OSAS)患者脂代谢紊乱、咽部软组织脂肪浸润在其发病机制中的作用。方法 :测量OSAS组和对照组的脂代谢临床指标和悬雍垂大小 ;应用图像分析技术在悬雍垂组织切片上分析各主要成分构成比 ,光镜和电镜观察悬雍垂病理学改变。结果 :①两组患者体重指数、颈围、腰围、腰髋比 (WHR)、悬雍垂重量和体积及血脂差异有显著性意义。②OSAS组悬雍垂各成分构成比中的脂肪和肌肉增加 ,纤维组织减少 (P <0 .0 1)。光镜显示 :OSAS组悬雍垂中有明显的脂肪细胞浸润 ,肌纤维排列紊乱 ,呈多形性改变 ,包括局灶性肥大、萎缩和退变 ;电镜显示 :OSAS组肌纤维局灶性Z线模糊、扭曲和消失 ,部分呈点状或片状肌纤维断裂 ,肌节溶解消失 ,肌原纤维间有局灶性脂滴浸润。③两组病例咽悬雍垂脂肪浸润程度与颈围、腰围、WHR、悬雍垂大小以及血脂中TC、TC/HDL正相关 ;OSAS组咽悬雍垂脂肪浸润程度与睡眠呼吸暂停低通气指数正相关。结论 :OSAS患者存在脂代谢紊乱 ,咽部过多的脂肪浸润可能通过改变气道大小、形状和咽壁顺应性 ,促成或加重气道阻塞 ,从而成为OSAS发病的重要因素之一。
Objective: To investigate the role of dyslipidemia and fat infiltration of pharynx in the pathogenesis of obstructive sleep apnea syndrome (OSAS). Methods: The clinical indexes of lipid metabolism and the size of uvula were measured in OSAS group and control group. The constituent ratio of the main components was analyzed on the uvula slice by using image analysis technique. The pathological changes of uvula were observed under light and electron microscope. Results: ① Body mass index, neck circumference, waist circumference, waist-hip ratio (WHR), uvula weight and volume, and blood lipid differences were significantly different between the two groups. ②OSAS group uvula composition ratio of the increase in fat and muscle fibers decreased (P <0.01). Light microscopy showed that the OSAS group had significant adipocyte infiltration in the uvula, the muscle fibers were disordered and showed pleomorphic changes, including focal hypertrophy, atrophy and degeneration. Electron microscopy showed that the focal Z line of the muscle fibers of the OSAS group was vague and distorted And disappeared, some were spotted or lamellar muscle fiber rupture, sarcomere dissolved disappear, there are focal lipid droplets infiltration between myofibrils. (3) The degree of fat infiltration of pharyngeal uvula was positively correlated with TC, TC / HDL in neck, waist circumference, WHR, uvula and lipids in both groups. The degree of pharyngeal uvula fat infiltration and sleep apnea-hypopnea index Positive correlation. CONCLUSIONS: Lipid metabolism is disturbed in patients with OSAS. Lipid infiltration in the pharynx may contribute to or aggravate airway obstruction by changing the size, shape and compliance of the pharyngeal wall. OSAS is one of the important factors in the pathogenesis of OSAS.