阻塞性睡眠呼吸暂停低通气综合征患者呼吸功能与颈动脉内膜中层厚度的关系研究

周东霞; 刘顺林

doi:10.16766/j.cnki.issn.1674-4152.001917

阻塞性睡眠呼吸暂停低通气综合征患者呼吸功能与颈动脉内膜中层厚度的关系研究

doi: 10.16766/j.cnki.issn.1674-4152.001917

周东霞^1, ,,
刘顺林²

1.
安吉县第三人民医院内科，浙江湖州 313301
2.
湖州市第三人民医院老年病科，浙江湖州 313000

基金项目:

浙江省医药卫生科技计划项目 2017KY646

详细信息

通讯作者:
周东霞，E-mail: 1394993968@qq.com

中图分类号: R56 R445.1
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- 被引次数: 0
出版历程
- 收稿日期: 2020-11-24
- 网络出版日期: 2022-02-16

Relationship between respiratory function and carotid intima-media thickness in patients with obstructive sleep apnoea hypopnea syndrome

ZHOU Dong-xia^{1
, ,},
LIU Shun-lin²

1.
Department of Internal Medicine, Anji Third People's Hospital, Huzhou, Zhejiang 313301, China

摘要

摘要: 目的探究阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome，OSAHS)呼吸功能与颈动脉病变程度的关系，以提高对OSAHS的评估。方法选择2016年7月—2019年12月于安吉县第三人民医院治疗的OSAHS患者127例作为研究对象，均行多导睡眠监测(polysomnography，PSG)，根据TS90%将患者分为轻度低氧组(34例)、中度低氧组(52例)和重度低氧组(41例)，比较不同组别PSG指标、颈动脉斑块检出率、颈动脉内膜中层厚度(IMT)，采用Pearson相关分析探究PSG指标与颈动脉IMT的关系。结果轻度低氧组呼吸紊乱指数(AHI)、氧减指数(ODI)、氧减时间均低于中度低氧组和重度低氧组(均P＜0.05)，轻度低氧组LSaO₂为(77.47±6.58)%，高于中度低氧组[(72.37±7.37)%]和重度低氧组[(68.37±6.90)%]。轻度低氧组IMT、斑块数量以及斑块Crouse积分均低于中度低氧组和重度低氧组(均P＜0.05)。3组斑块检出率分别为14.71%、25.00%、53.66%，差异有统计学意义(χ²=14.793，P＜0.05)。Pearson相关性分析显示，IMT与AHI、ODI和最大氧减呈正相关(均P＜0.05)，与LSaO₂呈负相关(r=-0.605，P＜0.05)。结论 OSAHS呼吸功能与颈动脉病变相关，其中AHI、ODI越高，其IMT越高，在临床上需要早期明确PSG相关指标并及时干预，降低颈动脉病变程度。
- 阻塞性睡眠呼吸暂停低通气综合征 /
- 颈动脉内膜中层厚度 /
- 呼吸紊乱指数 /
- 氧减指数 /
- 最低氧饱和度
Abstract: Objective To explore the relationship between respiratory function and carotid artery lesions in patients with obstructive sleep apnoea hypopnea syndrome (OSAHS). Methods A total of 127 patients with OSAHS who were treated in the Anji Third People's Hospital from July 2016 to December 2019 were selected as the research objects. All patients were divided into mild hypoxia group (n=34), moderate hypoxia group (n=52) and severe hypoxia group (n=41). Polysomnography (PSG) index, carotid plaque detection rate and intima-media thickness (IMT) of the different groups were compared. Pearson correlation was used to analyse the relationship between PSG and carotid IMT. Results apnea-hypopnea index (AHI), Oxygen Desaturation Index (ODI) and oxygen desaturation lasting time in mild hypoxia group were lower than those in moderate hypoxia group and severe hypoxia group (all P < 0.05). lowest oxygen saturation(LSaO₂) in mild hypoxia group was (77.47±6.58)%, which was higher than that in moderate hypoxia group [(72.37±7.37)%] and severe hypoxia group [(68.37±6.90)%]. IMT, plate number and Crouse score in mild hypoxia group were lower than those in moderate hypoxia group and severe hypoxia group (all P < 0.05). The detection rates of plaque in the mild, moderate and severe hypoxia groups were 14.71%, 25.00% and 53.66%, respectively, and the difference was statistically significant (χ²=14.793, P < 0.05). Pearson correlation analysis showed that IMT was positively correlated with AHI, ODI and Maximal accumulated oxygen deficit (MAOD, all P < 0.05) and negatively correlated with LSaO₂ (r=-0.605, P < 0.05). Conclusion The respiratory function of patients with OSAHS is related to carotid artery disease. The higher the AHI and ODI, the higher the IMT. PSG-related indexes must be identified and intervened in time to reduce the degree of carotid artery disease.
- Obstructive sleep apnoea hypopnea syndrome /
- Carotid intima-media thickness /
- Respiratory disturbance index /
- Oxygen desaturation index /
- Minimum oxygen saturation

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表 1 3组OSAHS患者一般资料与PSG指标比较(x±s)

组别	例数	年龄(岁)	性别[例(%)]		平均动脉压(mm Hg)	空腹血糖(mmol/L)	病程(月)	AHI(次/h)	LSaO₂(%)	ODI(次/h)	最长氧减时间(s)	最大氧减时间(s)
组别	例数	年龄(岁)	男性	女性	平均动脉压(mm Hg)	空腹血糖(mmol/L)	病程(月)	AHI(次/h)	LSaO₂(%)	ODI(次/h)	最长氧减时间(s)	最大氧减时间(s)
轻度低氧组	34	42.3±6.5	20(58.82)	14(41.18)	83.26±5.68	5.35±0.46	8.32±3.27	12.38±3.28	77.47±6.58	20.37±5.48	50.49±2.38	15.26±3.48
中度低氧组	52	42.9±6.9	26(50.00)	26(50.00)	84.36±5.36	5.43±0.52	8.50±3.43	25.49±6.58^c	72.37±7.37^c	32.37±7.68^c	60.99±3.48^c	18.90±3.02^c
重度低氧组	41	43.2±5.8	18(43.90)	23(56.10)	84.83±5.50	5.39±0.43	8.83±4.02	37.47±5.49^cd	68.37±6.90^cd	49.37±10.37^cd	68.08±3.27^cd	26.37±3.00^cd
统计量		2.363^a	1.661^b		2.856^a	0.834^a	1.463^a	68.372^a	9.037^a	120.382^a	44.026^a	32.102^a
P值		0.173	0.436		0.103	0.736	0.305	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001
注：^a为F值，^b为χ²值；与轻度低氧组比较，^cP＜0.05；与中度低氧组相比，^dP＜0.05。1 mm Hg=0.133 kPa。

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表 2 3组OSAHS患者彩色超声多普勒指标比较(x±s)

组别	例数	IMT(mm)	斑块数量(个)	斑块Crouse积分(分)	斑块检出率[例(%)]
轻度低氧组	34	0.97±0.10	10.27±4.39	2.36±0.73	5(14.71)
中度低氧组	52	1.26±0.08^a	17.27±4.38^a	3.48±0.70^a	13(25.00)
重度低氧组	41	1.39±0.09^ab	28.37±5.02^ab	4.12±0.65^ab	22(53.66)
统计量		10.283^c	22.302^c	14.389^c	14.793^d
P值		＜0.001	＜0.001	＜0.001	＜0.001
注：与轻度低氧组比较，^aP＜0.05；与中度低氧组相比，^bP＜0.05；^c为F值，^d为χ²值。

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表 3 影响IMT值的相关性分析

变量	IMT值
变量	r值	P值
AHI	0.893	＜0.001
LSaO₂	-0.605	＜0.001
ODI	0.883	＜0.001
最长氧减时间	0.673	＜0.001
最大氧减时间	0.572	＜0.001

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参考文献(15)

[1]	MOISE L G, MARTA D S, RAŞCU A, et al. Serum lipoprotein-associated phospholipase A2 in males with metabolic syndrome and obstructive sleep apnea[J]. Acta Endocrinol(Buchar), 2018, 14(1): 36-42. http://www.researchgate.net/publication/324713086_Serum_Lipoprotein-Associated_Phospholipase_A2_in_Males_With_Metabolic_Syndrome_and_Obstructive_Sleep_Apnea
[2]	MALAKASIOTI G, ALEXOPOULOS E I, BATZIOU N, et al. Frequency of moderate-to-severe obstructive sleep apnea syndrome among children with snoring and blood pressure in the hypertensive range[J]. Pediatr Nephrol, 2020, 35(8): 1491-1498. doi: 10.1007/s00467-020-04544-0
[3]	LI J, LIN X, LI H, et al. Right ventricular diastolic dysfunction in patients with obstructive sleep apnea syndrome[J]. Echocardiography, 2020, 37(2): 317-322. doi: 10.1111/echo.14600
[4]	GENRE F, RUEDA-GOTOR J, REMUZGO-MARTÍNEZ S, et al. Implication of osteoprotegerin and sclerostin in axial spondyloarthritis cardiovascular disease: study of 163 Spanish patients[J]. Clin Exp Rheumatol, 2018, 36(2): 302-309. http://smartsearch.nstl.gov.cn/paper_detail.html?id=3f65a26d062df8c49c32ea771e002450
[5]	LIN Z P, LIN H L, YU X P, et al. TLR4 mediates inflammation and hepatic fibrosis induced by chronic intermittent hypoxia in rats[J]. Mol Med Rep, 2020, 22(2): 651-660. doi: 10.3892/mmr.2020.11134
[6]	HE L, LIAO X, ZHU G, et al. miR-126a-3p targets HIF-1α and alleviates obstructive sleep apnea syndrome with hypertension[J]. Hum Cell, 2020, 33(4): 1036-1045. doi: 10.1007/s13577-020-00404-z
[7]	中华耳鼻咽喉头颈外科杂志编辑委员会, 中华医学会耳鼻咽喉头颈外科学分会咽喉学组. 阻塞性睡眠呼吸暂停低通气综合征诊断和外科治疗指南[J]. 中华耳鼻咽喉头颈外科杂志, 2009, 44(2): 95-96. https://www.cnki.com.cn/Article/CJFDTOTAL-SYKQ201305041.htm
[8]	孟颖, 王大巍. 急性脑梗死患者血尿酸水平与颈动脉粥样硬化的相关性研究[J]. 中华全科医学, 2019, 17(10): 1681-1683, 1752. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201910019.htm
[9]	吴慕坤, 孙建军. 阻塞性睡眠呼吸暂停低通气综合征气道解剖功能异常的研究进展[J]. 中国眼耳鼻喉科杂志, 2020, 20(3): 266-268. https://www.cnki.com.cn/Article/CJFDTOTAL-YRBH202003043.htm
[10]	ZHANG X Q, LIU L J, LI X Y, et al. Effect of minimally invasive surgery on the sleep quality and work ability of patients with obstructive sleep apnea-hypopnea syndrome[J]. Sleep Breath, 2020. DOI: 10.1007/s11325-020-02229-4.
[11]	杨芳, 张佳星, 任歆, 等. 缺血性脑卒中和非脑卒中病人颈动脉内中膜厚度与狭窄程度的关系[J]. 中西医结合心脑血管病杂志, 2020, 18(19): 3299-3301. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYYY202019041.htm
[12]	郑曙光, 郭香香, 郝晓俊. 阻塞性睡眠呼吸暂停低通气综合征合并无症状性脑梗死患者血清OX-LDL和Hcy水平的研究[J]. 中国药物与临床, 2020, 20(17): 2882-2884. https://www.cnki.com.cn/Article/CJFDTOTAL-YWLC202017026.htm
[13]	KONG D, QIN Z, WANG W, et al. Effect of obstructive sleep apnea on carotid artery intima media thickness related to inflammation[J]. Clin Invest Med, 2017, 40(1): E25-E33. doi: 10.25011/cim.v40i1.28051
[14]	GONG L J, WANG X Y, GU W Y, et al. Pinocembrin ameliorates intermittent hypoxia-induced neuroinflammation through BNIP3-dependent mitophagy in a murine model of sleep apnea[J]. J Neuroinflammation, 2020, 17(1): 337. http://www.ncbi.nlm.nih.gov/pubmed/?term=33176803
[15]	ZHOU J P, LIN Y N, LI N, et al. Angiotensin-(1-7) rescues chronic intermittent hypoxia-aggravated transforming growth Factor-β-mediated airway remodeling in murine and cellular models of asthma[J]. J Pharmacol Exp Ther, 2020, 375(2): 268-275. http://www.researchgate.net/publication/344129282_Angiotensin-1-7_rescues_chronic_intermittent_hypoxia-aggravated_TGF-b-mediated_airway_remodeling_in_murine_and_cellular_models_of_asthma