血管超声对阻塞性睡眠呼吸暂停综合征患者早期动脉粥样硬化检测指标的研究
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江苏省人民医院临床诊疗新技术项目(303070981KA10)


The study on indexes of early atherosclerosis in patients with obstructive sleep apnea syndrome by vascular ultrasonography
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    摘要:

    目的:运用血管超声探讨阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)与早期动脉粥样硬化间的相互关系-方法:选取不合并高血压的OSAS患者37例,以及40例同期健康志愿者作为对照组-应用血管超声内皮功能检测方法测得肱动脉血流介导的血管扩张性(flow-mediated dilation,FMD),运用动脉僵硬度分析(quantitative arterial stiffness,QAS)技术测量颈动脉各项弹性参数,包括血管扩张度(vascular expansibility,VE)-顺应性系数(compliance coefficient,CC)-僵硬度(stiffness index,-茁)-脉搏波传播系数(pulse wave velocity,PWV),分析两组上述指标间的差别-并用多导睡眠呼吸监测(polysomnograph,PSG)测得OSAS组的睡眠呼吸暂停低通气指数(apnea-hypopnea index,AHI)和最低脉氧饱和度(minimal pulse oxyhemoglobin saturation,miniSpO2)等血氧饱和度相关指标,与FMD值之间进行相关回归分析-对OSAS组中的20例患者进行持续气道内正压(continuous positive airway pressure,CPAP)治疗,并分析治疗前后各项参数的改变-结果:① 与正常对照组相比,OSAS组的FMD值及颈动脉弹性系数VE-CC明显降低,而-茁值及PWV明显升高(P < 0.05);② OSAS组中肱动脉FMD值与AHI-年龄--茁呈负相关(r = -0.325~-0.378,P均 < 0.05),与miniSpO2呈正相关(r = 0.504,P < 0.01),通过多元线性回归分析显示病例组中miniSpO2是FMD的独立预测因素(R2 = 0.548,P < 0.05);③与治疗前相比,治疗3个月后 FMD值及颈动脉弹性系数CC明显上升,而-茁值及PWV下降显著(P < 0.05)-结论:血管超声可发现OSAS患者早期就存在内皮损伤及弹性功能减退,同时CPAP治疗能够有效改善患者血管弹性及内皮功能-

    Abstract:

    Objective:To investigate the relationship between obstructive sleep apnea syndrome(OSAS) and early atherosclerosis using vascular ultrasonography. Methods:Thirty-seven OSAS patients without hypertension (OSAS group) and forty normal subjects were enrolled in the study. Flow-mediated dilation(FMD) was investigated with brachial artery ultrasound examination. In addition,the arterial elastic parameters including vascular expansibility(VE),compliance coefficient(CC),stiffness index(-茁) and pulse wave velocity (PWV) through quantitative arterial stiffness (QAS) analysis were measured. The differences of the parameters between two groups were analyzed. In the OSAS group,polysomnograph(PSG) data were recorded and analyzed including apnea-hypopnea index (AHI),minimal pulse oxyhemoglobin saturation(miniSpO2). Correlations and regression were calculated between indices of oxygen saturation and FMD. Twenty patients in OSAS group underwent continuous positive airway pressure(CPAP) treatment for three months. Results:① Compared with normal control group,FMD,VE and CC in OSAS group were significantly lower,but -茁 and PWV were significantly higher(P < 0.05). ② Through pearson correlation analysis,in the OSAS group,FMD was negatively correlated with AHI,age and -茁(r = -0.325~-0.378,all P < 0.05),but positively correlated with miniSpO2(r = 0.504,P < 0.01). Through stepwise multiple linear regression analysis,miniSpO2 was a significant determinant for FMD (R2 = 0.548,P < 0.05). ③ Compared with parameters before treatment,there was a significant increase in FMD and CC,but the parameters of arterial stiffness,including PWV and -茁,were significantly lower(P < 0.05). Conclusion:Endothelial dysfunction and the arterial elasticity decrease are present in OSAS patients. Vascular ultrasonography could be performed in detection of early atherosclerosis. CPAP treatment can improve vascular elasticity and endothelium function effectively.

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俞飞虹,林红军,叶新华.血管超声对阻塞性睡眠呼吸暂停综合征患者早期动脉粥样硬化检测指标的研究[J].南京医科大学学报(自然科学版),2012,(4):555-559

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  • 收稿日期:2011-10-14
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