摘要
目的观察阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)在急性冠脉综合征(acute coronary syndrome,ACS)患者中的患病情况,分析OSA对ACS患者炎症标志物水平的影响。方法前瞻性连续纳入2015年6月至2017年5月在北京安贞医院就诊,并接受睡眠呼吸监测的ACS患者,根据睡眠呼吸暂停低通气指数(apnea hypopnea index,AHI)将患者分为正常-轻度OSA组(AHI<15次/h)和中重度OSA组(AHI≥15次/h),收集基线资料、实验室检查、睡眠呼吸监测等结果。采用LSD-t检验、Mann-Whitney U检验或χ^2检验比较两组患者炎症标志物的差异;采用Spearman秩相关检验分析OSA相关参数与高敏C反应蛋白(high sensitivity C-reactive protein,hs-CRP)的相关性。结果共纳入ACS患者836例,其中正常-轻度OSA组408例,中重度OSA组428例。中重度OSA组的白细胞(×10^9L)[7.78(6.33,9.86)vs 7.29(6.01,9.16),P=0.006]、中性粒细胞(×10^9L)[5.05(3.84,7.23)vs 4.80(3.74,6.66),P=0.044]、单核细胞(×10^9L)[0.42(0.33,0.54)vs 0.39(0.31,0.51),P=0.033]、hs-CRP(mg/L)[3.18(1.10,11.52)vs 1.78(0.65,6.46),P<0.01]、纤维蛋白原(g/L)[3.17(2.87,3.74)vs 2.97(2.59,3.50),P=0.002]、尿酸(μmol/L)[360(302,422)vs 341(283,407),P=0.006]水平高于正常-轻度OSA组;AHI(相关系数=0.171,R^2=0.020,P<0.01)、ODI(氧减指数)(相关系数=0.201,R^2=0.027,P<0.01)、TSaO2<90%(血氧饱和度<90%的时间百分比)(相关系数=0.105,R^2=0.005,P<0.01)与hs-CRP成正相关,最低SaO2(相关系数=-0.100,R^2=0.001,P=0.008)、平均SaO2(相关系数=-0.127,R^2=0.006,P<0.01)与hs-CRP成负相关。结论伴中重度OSA(AHI≥15次/h)的ACS患者炎症标志物水平升高;睡眠呼吸检测各项主要参数均与ACS患者的hs-CRP水平显著相关。在未来的ACS管理中应考虑OSA的诊断和监测。
Objective To examine the prevalence of obstructive sleep apnea (OSA) in patients with acute coronary syndrome (ACS), and to evaluate the relationship of OSA with inflammatory biomarkers in ACS patients. Methods Patients with ACS treated at Beijing Anzhen Hopital from June 2015 to May 2017 were enrolled. Subjects were evaluated for OSA by sleep study, and were divided into a normal-mild OSA group (Apnea Hypopnea Index, AHI < 15 times/h) and a moderate-severe OSA group (AHI ≥ 15 times/h). Laboratory examination and sleep study were monitored to analyze the effects of OSA on biomarkers by LSD-t test, Mann-whitney U test, or Chi-square test. Correlation analysis was performed to analyze the association of OSA with high sensitivity C-reactive protein (hs-CRP) by Spearman correlation anaylsis. Results A cohort of 836 patients with ACS were enrolled including 408 patients in the normal-mild OSA group and 428 patients in the moderate-severe OSA group. The levels of leukocyte(×10^9 L)[7.78 (6.33, 9.86) vs 7.29 (6.01, 9.16), P=0.006], neutrophils(×10^9 L)[5.05 (3.84, 7.23) vs 4.80 (3.74, 6.66), P=0.044], monocytes(×10^9 L)[0.42 (0.33, 0.54) vs 0.39 (0.31, 0.51), P=0.033], hs-CRP(mg/L)[3.18 (1.10, 11.52) vs 1.78 (0.65, 6.46), P<0.01], fi brinogen(g/L)[3.17 (2.87, 3.74) vs 2.97 (2.59, 3.50), P=0.002], and uric acid(μmol/L)[360 (302, 422) vs 341(283, 407), P=0.006] in the moderate-severe OSA group were significant higher than those in the normal-mild OSA group. AHI (correlation coefficient=0.171, R2 =0.020, P<0.01), ODI (correlation coefficient = 0.201, R^2 =0.027, P<0.01), and TSaO2 < 90%(correlation coeffi cient = 0.105, R^2 =0.005, P<0.01) were positively correlated with hs-CRP;minimal SaO2 (correlation coeffi cient=-0.100, R^2 =0.001, P=0.008) and mean SaO2 (correlation coeffi cient =-0.127, R2 = 0.006, P<0.01) were negatively correlated with hs-CRP. Conclusions For patients with ACS, the level of infl ammatory markers in the moderate-severe OSA group is signifi cantly higher than that in the normal-mild OSA group.
作者
郝问
范婧尧
王晓
赵冠棋
周生辉
李奥博
郭芮丰
石涵
李泽萱
聂绍平
魏永祥
Hao Wen;Fan Jingyao;Wang Xiao;Zhao Guanqi;Zhou Shenghui;Li Aobo;Guo Ruifeng;Shi Han;Li Zexuan;Nie Shaoping;Wei Yongxiang(Emergency & Critical Care Center, Beijing Anzhen Hopital, Capital Medical University, Beijing 100029,China;Otolaryngology Head and Neck Surgery Center, Beijing Anzhen Hopital, Capital MedicalUniversity, Beijing 100029, China)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2019年第7期825-830,共6页
Chinese Journal of Emergency Medicine
基金
国家国际科技合作专项(2015DFA30160)
国家自然科学基金青年项目(81600209)
北京市医管局重点医学发展计划(ZYLX201710)
北京市医院管理局"青苗"计划(QML20160605)
首都医科大学基础临床科研合作课题(16JL17).
