以舌后区阻塞为主的睡眠呼吸暂停低通气综合征患者颏舌肌病理形态的电镜观察

刘亚奇; 王赛; 杨怀安

doi:10.13201/j.issn.1001-1781.2014.24.013

以舌后区阻塞为主的睡眠呼吸暂停低通气综合征患者颏舌肌病理形态的电镜观察

- 中国医科大学附属第一医院耳鼻咽喉头颈外科(沈阳, 110001)

详细信息

通讯作者: 杨怀安,E-mail:dr_yanghuaian@163.com

中图分类号: R563.8

收稿日期: 2014-06-18

Pathologic changes of the genioglossus in patients with obstructive sleep apnea hypopnea syndrome dominated by lingual region obstruction

- Department of Otorhinolaryngology Head and Neck Surgery, First Hospital of China Medical University, Shenyang, 110001, China

More Information

Corresponding author: YANG Huaian, E-mail: dr_yanghuaian@163.com

Received Date: 18 June 2014

摘要

摘要: 目的:研究以舌后区阻塞为主的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的颏舌肌在透射电镜下的病理形态学改变,并探讨其在OSAHS发病机制中的作用及临床意义。方法:选取接受舌体部分切除术及UPPP治疗的OSAHS患者38例,根据AG监测的AHI值将患者分为轻-重度组(30结果:透射电镜下对照组的颏舌肌组织肌纤维排列规整,肌间线粒体形状规则;所有OSAHS患者的颏舌肌标本都同时存在以下3种变化:轻度变化肌纤维萎缩、排列稀松,间隙增大,局部肌丝水肿,肌束间结缔组织增生,线粒体肿胀,部分呈球形,嵴尚清晰;中度变化肌纤维明显萎缩,直径大小不一,排列紊乱,Z线距离缩短、扭曲,部分肌丝断裂、溶解消失,肌束间结缔组织明显增生,线粒体肿大呈空泡样变性,嵴模糊、变短及形态不规则;重度变化肌纤维大量断裂、溶解,排列紊乱,凝集成团块状,呈点状或片状排列,Z线扭曲消失,线粒体大小不一,呈空泡样变性,嵴消失,有的呈絮状改变,部分样本可见线粒体堆积现象。且随AHI的增高,轻度变化出现比率降低,重度变化出现比率则升高。结论:OSAHS患者颏舌肌及线粒体的改变是一个连续、渐进的过程,且随OSAHS程度加重,舌体颏舌肌组织病理形态学变化有逐渐加重的趋势。
- 睡眠呼吸暂停低通气综合征 /
- 阻塞性 /
- 颏舌肌 /
- 透射电镜 /
- 病理形态学
Abstract: Objective:To study the pathological changes of genioglossus with transmission electron microscope (TEM) in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) dominated by lingual region obstruction,and to explore the role of tongue organizations in the pathogenesis and its clinical significance.Method:Thirty-eight cases of genioglossus were collected from the patients received UPPP and partial glossectomy (3060 severe group 15 cases), 6 adult patients without oropharyneal and hypopharyneal obstructive disease received tongue tumor resection or trauma debridement surgery were collected as control group. The features of morphological changes in genioglossus were observed by TEM.Result:Under the TEM, in the control group,the muscle fibers of the genioglossus organization arranges regular, mitochondrial shape between muscle was regular;The below 3 kinds of variations existed simultaneously in all genioglossus specimens of all the OSAHS patients. In the mild group, myofibrillar atrophied, arranged sloppily, the gap was increased, localized filaments were edema, connective tissue between muscle bundles was proliferated, mitochondria were swelling, some were spherical, crests were still clear; In the moderate group, myofibrillar obviously atrophied with different diametric sizes and disorderliness, the Z lines were shortened or distorted, part of the myofibrillar ruptured, dissolved or disappeared, the connective tissues between muscle bundles were obviously proliferated, mitochondria were swellen, vacuolar degeneration, crests were vague, shorten and irregulatio; In the severe group, a large number of myofibrillar were fractured, dissolved, disorganized, integrated condensate lumpy, spotty or flake arranged, Z-lines were distorted or disappeared. Mitochondria were sizes, showed vacuolar degeneration, crests were disappeared, some changes were flocculent, mitochondria accumulation phenomenon was visible in some samples.Moreover, with the AHI increased, the occurence ratio of mild changes was decreased while severe changes occurence ratio increased.Conclusion:The changes of genioglossus and mitochondrial in OSAHS patients is a continuous, progressive process, moverover, with the aggravation of OSAHS, genioglossus histopathological changes had gradually worsening tendency.
- sleep apnea hypopnea syndrome /
- obstructive /
- genioglossus /
- transmission electron microscope /
- pathologic changes

HTML全文

参考文献(19)

[1]	CAPLES S M, GAMI A S, SOMERS V K.Obstructive sleep apnea[J].Am Intem Med, 2005, 142:187-197.
[2]	唐洁, 龚淼, 张佐, 等.舌体及相关肌肉与上气道的关系[J].宁夏医学杂志, 2011, 33 (2):186-187.
[3]	OLIVEN A, TOV N, GEITINI L, et al.Effect of genioglossus contraction on pharyngeal lumen and airflow in sleep apnoea patients[J].Eur Respir J, 2007, 30:748-758.
[4]	FUJITA S.Obstructive sleep apnea syndrome:Pathophysiology, upper airway evaluation and surgical treatment[J].Ear Nose Throat J, 1993, 72:67-72, 75-76.
[5]	陈丽艳, 叶京英, 崔吉亨.阻塞性睡眠呼吸暂停低通气综合征患者颏舌肌肌电活性分析[J].中国耳鼻咽喉头颈外科, 2005, 12 (7):453-457.
[6]	王璋, 司良毅, 廖友斌.大鼠睡眠呼吸暂停综合征动物模型的建立[J].中国实验动物学报, 2006, 14 (1):40-43.
[7]	李勤, 李翀, 刘皓, 等.慢性间歇性低氧对大鼠颏舌肌超微结构和线粒体功能的影响[J].中华老年多器官疾病杂志, 2011, 10 (1):7-10.
[8]	苏振福, 曹根玉, 刘新, 等.舌体部分切除联合腭咽成形术治疗阻塞性睡眠呼吸暂停综合征8例疗效观察[J].临床耳鼻咽喉科杂志, 2002, 16 (7):371-372.
[9]	康全清, 周晓红, 许珉, 等.经口舌根梭形切除治疗阻塞性睡眠呼吸暂停低通气综合征的临床疗效[J].临床耳鼻咽喉科杂志, 2007, 21 (6):241-243.
[10]	陆传新.舌肌的功能形态学[J].四川解剖学杂志, 1995, 3 (3):176-177.
[11]	李赛楠, 杨怀安, 姜学钧, 等.不同程度阻塞性睡眠呼吸暂停低通气综合征患者腭咽肌病理形态的电镜观察[J].中华耳鼻咽喉头颈外科杂志, 2011, 46 (8):638-641.
[12]	BIXLER E O, VGONTZAS A N, LIN H M, et al.Prevalence of sleep-disor-dered breathing in women;effects of gender[J].Am J Respir Crit Care Med, 2001, 163:608-613.
[13]	NETZER N C, ELIASSON A H, STROHL K P.Women with sleep apnea have lower levels of sex hormones[J].Sleep Breath, 2003, 7:25-29.
[14]	霍红, 李五一, 高志强, 等.上气道测压在悬雍垂腭咽成形术后失败患者阻塞定位的应用[J].山东大学耳鼻喉眼学报, 2007, 21 (6):524-527.
[15]	罗伟, 缪东生, 常英展, 等.便携式睡眠监测定位仪和多道睡眠监测同步检查的比较[J].中国耳鼻咽喉头颈外科, 2010, 17 (2):94-97.
[16]	CARRERA M, BARBE F, SAULEDA J, et al.Effects of obesity upon genioglossus structure and function in obstructive sleep apnea[J].Eur Respir J, 2004, 23:425-429.
[17]	何春燕, 张盛忠, 叶京英.阻塞性睡眠呼吸暂停低通气综合征患者腭咽肌组织病理学观察[J].中国耳鼻咽喉头颈外科, 2008, 15 (5):301-303.
[18]	BASSIOUNY A, NASR S, MASHALY M, et al.Electron microscopy study of peripheral nerves in the uvulae of snorers and obstructive sleep apnoea patients[J].J Laryngol Otol, 2009, 123:203-207.
[19]	SFORZA E, BACON W, WEISS T, et al.Upper airway collapsibility and cephalometric variables in patients with obstructive sleep apnea[J].Am J Respir Crit Care Med, 2000, 161 (2Pt 1):347-352.