肥胖低通气综合征患者嗜睡与血清瘦素水平的关系及气道持续正压通气治疗效果分析被引量：1

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摘要目的探讨肥胖低通气综合征(OHS)患者嗜睡症状与血清瘦素水平的相关性及气道持续正压通气(CPAP)治疗OHS的作用机制.方法选取2017年9月至2019年9月在杭州市萧山区第一人民医院确诊的OHS患者28例作为OHS组,阻塞性睡眠呼吸暂停低通气综合征(OSAHS)伴肥胖患者32例作为肥胖OSAHS组,OSAHS不伴肥胖患者30例作为非肥胖OSAHS组,单纯肥胖无OSA患者20例作为单纯肥胖组.采用Epworth嗜睡量表(ESS)评估患者嗜睡情况,多导睡眠监测(PSG)记录睡眠呼吸暂停低通气指数(AHI)、最低血氧饱和度(SaO2)等参数,测定各组患者的BMI、血清瘦素水平等,使用自动血气分析仪测得动脉血氧分压(PaO_(2))、动脉血CO_(2)分压(PaCO_(2))及pH值.比较各组患者的ESS评分、血清瘦素水平、血气分析指标及PSG参数,并进行相关性分析.OHS组患者接受CPAP治疗6个月,比较治疗前后上述指标变化.结果 OHS组患者的PaO_(2)、PaCO_(2)、HCO3-、瘦素水平、ESS评分及ESS评分>10分占比与其他三组比较,差异有统计学意义(P<0.05).肥胖OSAHS组和非肥胖OSAHS组患者的PaO_(2)、瘦素水平、ESS评分与单纯肥胖组比较,差异有统计学意义(P<0.05).OHS组患者的瘦素水平、ESS评分均与BMI、AHI、PaCO_(2)呈明显正相关(P<0.01),与PaO_(2)呈明显负相关(P<0.01),瘦素水平与ESS呈明显正相关(P<0.01).经CPAP治疗后,OHS组患者的PaO_(2)、PaCO_(2)、瘦素水平、ESS评分及ESS评分>10分占比均较治疗前明显改善,差异有统计学意义(P<0.01).结论 OHS患者的嗜睡症状及血清瘦素水平会随着病情加重而发生明显变化,且这种变化存在相关性,CPAP治疗可以改善OHS患者的嗜睡症状、降低血清瘦素水平. Objective To investigate the correlation between drowsiness and serum leptin level in patients with obese hypoventilation syndrome(OHS),and the mechanism of continuous positive airway pressure ventilation in the treatment of OHS.Methods Twenty-eight OHS patients diagnosed in the Xiaoshan Fist People's Hospital from September 2017 to September 2019 were selected as OHS group,32 obstructive slep apneahypopnea syndrome(OSAHS)patients with obesity as obese OSAHS group,30 OSAHS patients without obesiy as non-obese OSAHS group,and 20 simple obesity patients without OSA as simple obesity group.Epworth sleepines sale(ESS)was used to evaluate the sleepiness of patients.Polysomnography(PSG)was used to record the parameters such as sleep apnea hypopnea index(AHI)and minimum blood oxygen saturation(SaO:).The BMI and serum leptin level of patients in each group were measured.The arterial partial prssure of oxygen(PaOa),arterial partial prssure of CO(PaCO:)and pH were measured by automatic blood gas analyzer.The ESS score,serum leptin level,blood gas analysis indexes and PSG parameters of patients in each group were compared,and the corelation was analyzed.Patients in OHS group received CPAP treatment for 6 months,and the changes of the above indexes before and after treatment were compared.Results The levek of PaOz,PaCO,HCO;,leptin,ESS score and the proportion of ESS score>10 in OHS group were significantly diferent from the other three groups(P<0.05).There were significant diferences in PaOz,leptin level and ESS score between obese OSAHS group and non-obese OSAHS group compared with simple obesity group(P<0.05),Leptin level and ESS score in OHS group were significantly positively correlated with BMI,AHI and PaCO:(P<0.01),negatively correlated with PaO:(P<0.01),and significantly positively corelated with ESS(P<0.01).Affer CPAP treatment,the levels of PaO,PaCO,leptin,ESS score and the proportion of ESS score>10 in OHS group were significanty improved compared with those before treatment(P<0.01).Conclusion The drowsinss symptom