摘要
目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的软腭组织和悬雍垂病理形态学变化。方法 52例OSAHS患者和9例对照组,按体重对OSAHS患者分组,分别测量所有试验对象体质指数(BMI)、颈围、腰围等指标,光镜和电镜观察软腭及悬雍垂病理学改变,应用图象分析技术对软腭组织切片分析,统计脂肪细胞成分构成比。结果①OSAHS超重组、正常体重组、对照组的BMI、颈围、腰围、腰髋比(wrist-hip circumference ratio,WHR)与OSAHS肥胖组差异具有统计学意义;②形态学观察OSAHS患者腭咽组织和悬雍垂组织学存在着相似的病理学改变:光镜下软腭和悬雍垂有明显的脂肪细胞浸润,肌纤维排列紊乱,肌纤维局灶性肥大、萎缩和退变等多形性改变,以萎缩为主;电镜下2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,脱髓鞘改变,肌原纤维间有局灶性脂滴浸润;③OSAHS各组图像分析脂肪组织面积与对照组比较差异具有统计学意义,而OSAHS患者组内脂肪组织面积差异无统计学意义;④OSAHS病例中肥胖组和超重组的颈围、腰围、WHR与软腭脂肪组织之间呈正相关;颈围、腰围、WHR和软腭脂肪组织面积比值与呼吸暂停低通气指数(AHI)之间呈正相关;而正常体重组中WHR与软腭脂肪组织之间呈正相关,WHR、软腭脂肪组织与AHI呈正相关。结论 OSAHS患者均存在不同程度脂代谢紊乱,伴有软腭脂肪浸润和腭咽部肌的病理性结构改变,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/加重气道阻塞,从而成为OSAHS发病的重要因素之一。
ObjectiveTo study the histopathological changes of soft palate and uvula in patients with obstructive sleep apnea hypopnea syndrome （OSAHS）.MethodsSpecimens from 52 patients with OSAHS and 9 nonOSAHS adult cadavers were acquired. The 52 cases with OSAHS were divided into three groups by body mass index （BMI）. The related clinical indexes in all groups were measured. Soft palate tissue sections were evaluated with light microscope （LM） and transmission electron microscope （TEM）. Fat constituent ratio in all sections was measured by quantitative morphometric image analysis technique.Results①The BMI, neck circumference, waist circumference, waisttohip circumference ratio （WHR） of the obese OSAHS group were significantly higher than those of the other groups. ②LM and TEM studies showed similar pathological changes in three subgroups with OSAHS. The LM showed excessive fatty infiltration, partial atrophy and/or hypertrophy, and disordered arrangement of muscle fibers. The TEM showed focal or spotted deformity of Z line, sarcomere loss and vacuolation. Lipid droplet infiltration was also detected in adjoining myofibril. ③A significant difference in fat constituent ratio in soft palate was observed between the OSHAS group and the control group, while the differences among obese, overweight and normal weight subgroups of OSAHS were insignificant. ④The degree of fatty infiltration in soft palate tissue was positively correlated with WHR and AHI in the three subgroups of OSAHS.ConclusionExcessive fatty infiltration of oropharyngeal tissues and pathological changes of musculi pharyngopalatinus might exist in subjects with OSAHS. Abundant oropharyneal fatty infiltration might play an important role in pathogenesis of OSAHS via changing the size and shape of pharyngeal airway and therefore changing the compliance of pharyngeal wall.
出处
《中国耳鼻咽喉颅底外科杂志》
CAS
2013年第6期485-490,共6页
Chinese Journal of Otorhinolaryngology-skull Base Surgery
