动脉僵硬度定量分析技术评价阻塞性睡眠呼吸暂停综合征患者颈动脉弹性功能

发布时间：2018-03-05 04:37

本文选题：阻塞性睡眠呼吸暂停综合征　切入点：颈动脉　出处：《南京医科大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的：(1)通过血管超声动脉僵硬度定量分析(quantitative arterial stiffness, QAS)技术探讨阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome, OSAS)患者颈动脉弹性参数的变化特征及临床意义。(2)运用血管超声探讨阻塞性睡眠呼吸暂停综合征与早期动脉粥样硬化间的相互关系。方法：阻塞性睡眠呼吸暂停综合征患者72例,根据有无合并高血压分为OSAS无高血压组(OSAS1组)37例及OSAS合并高血压组(OSAS2组)35例,40例同期健康志愿者为对照组。运用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)、僵硬度系数(stiffness index, β)、脉搏波传播系数(pulse wave velocity, PWV),分析三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)、氧饱和度低于90%时间占监测时间的百分比(time spent below oxygen saturation of90%, Ts90%)、氧减指数(oxygen desaturation index, ODI)等血氧饱和度相关指标,并将其与PWV之间进行相关回归分析。结果：(1)与正常对照组相比,OSAS1和OSAS2组的颈动脉弹性系数VE、CC明显降低,而β值及PWV明显升高(P0.05)。与OSAS1组相比较,OSAS2组CC值降低,β值及PWV升高(P0.05)。(2)应用Pearson相关分析发现病例组PWV与收缩压、AHI、ODI、年龄呈正相关(r=0.285-0.542,P均0.05),通过多元线性回归分析显示病例组中年龄、ODI是PWV的独立预测因素。结论：OSAS患者早期就存在动脉弹性功能减退,合并高血压后损伤更明显,应用QAS技术能够准确分析颈动脉弹性功能,对评价早期动脉粥样硬化具有一定的临床价值。目的：(1)评价经连续气道内正压通气治疗后对阻塞性睡眠呼吸暂停(OSAS)患者血管弹性及内皮功能的影响。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。运用动脉僵硬度分析(QAS)技术测量颈动脉各项弹性参数,包括血管扩张度(VE)、顺应性系数(CC)、僵硬度系数(β)、脉搏波传播系数(PWV),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),分析两组上述指标间的差别。并用多导睡眠呼吸监测(PSG)测得OSAS组的睡眠呼吸暂停低通气指数(AHI)和最低脉氧饱和度(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3个月前后各项参数的改变。结果：(1)与正常对照组相比,OSAS组的FMD值降低(P0.05)。(2) OSAS组中肱动脉FMD值与AHI、年龄、β呈负相关(r=-0.325～-0.378、P均0.05),与miniSpO2呈正相关(r=0.504,P0.01),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,P0.05)。(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p值及PWV下降显著(P0.05)。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治疗能够有效的改善患者血管弹性及内皮功能。
[Abstract]:Objective: (1) by vascular ultrasound quantitative analysis of arterial stiffness (Quantitative arterial stiffness, QAS) on obstructive sleep apnea syndrome (obstructive sleep apnea syndrome, OSAS) variation of carotid artery elasticity parameters of patients and clinical significance. (2) the use of ultrasound to obstructive sleep apnea syndrome the relationship between the early atherosclerosis.
Methods: obstructive sleep apnea syndrome patients 72 cases, according to whether the patients have hypertension were divided into OSAS group without hypertension (OSAS1 group) and 37 cases of OSAS with hypertension group (OSAS2 group) 35 cases and 40 healthy volunteers as control group. The use of the QAS technology to measure carotid elastic parameters, including blood vessels expansion ratio (vascular expansibility, VE), compliance coefficient (compliance coefficient, CC), stiffness coefficient (stiffness index, beta), pulse wave propagation coefficient (pulse wave velocity, PWV), analysis of three groups of the above indexes. And the difference between using polysomnography (polysomnograph, PSG) test OSAS group of sleep apnea hypopnea index (apnea-hypopnea, index, AHI) and the lowest pulse oxygen saturation (minimal pulse oxyhemoglobin saturation, miniSpO2), oxygen saturation of less than 90% percentage of the time monitoring time (time spent below oxygen SA Turation of90%, Ts90%), oxygen subtraction index (oxygen desaturation index, ODI) and other related indexes of blood oxygen saturation, and to carry out a correlation regression analysis between PWV and PWV.
Results: (1) compared with the normal control group, the coefficient of elasticity of carotid artery VE OSAS1 and OSAS2 group, CC decreased significantly, while beta and PWV increased significantly (P0.05). Compared with OSAS1 group, OSAS2 group, CC decreased, the beta value and increase of PWV (P0.05). (2) by Pearson the analysis found that PWV in patients with systolic blood pressure, AHI, ODI, was positively correlated with age (r=0.285-0.542, P < 0.05), through multiple linear regression analysis showed that age in the case group, ODI are independent predictors of PWV.
Conclusion: there is early arterial elasticity decline in OSAS patients, and it is more obvious after hypertension. QAS technology can accurately analyze carotid elasticity and has certain clinical value in evaluating early atherosclerosis.
Objective: (1) to evaluate the effects of continuous positive airway pressure (CV) therapy on vascular elasticity and endothelial function in patients with obstructive sleep apnea (OSAS).
Methods: a total of 37 OSAS patients with hypertension patients and 40 healthy volunteers as control group. The arterial stiffness (QAS) technique for measuring the carotid elastic parameters, including vascular dilation (VE), compliance coefficient (CC), stiffness coefficient (beta), pulse wave propagation coefficient (PWV), vascular dilatation of brachial artery flow mediated endothelial function testing method using blood vessel ultrasound (flow-mediated dilation, FMD), analysis the differences of the parameters between two groups. And polysomnography (PSG) measured in group OSAS sleep apnea hypopnea index (AHI) and the lowest pulse oxygen saturation (miniSpO2) and oxygen saturation index, regression analysis and FMD value. In 20 cases of patients in OSAS group were continuous positive airway pressure (continuous positive airway pressure, CPAP) treatment and analysis before and after treatment for 3 months each Changes in the parameters of the item.
Results: (1) compared with the normal control group, OSAS group, FMD decreased (P0.05). (2) FMD of the brachial artery in group OSAS and AHI, age was negatively related to beta (r=-0.325 ~ -0.378, P 0.05), was positively correlated with miniSpO2 (r=0.504, P0.01), through multiple linear regression the analysis shows that miniSpO2 in the case group is an independent predictor of FMD (R2=0.548, P0.05). (3) compared with before treatment, after 3 months of treatment, FMD value and elasticity of carotid CC increased obviously, and the value of P and PWV decreased significantly (P0.05).
Conclusion: vascular ultrasound can detect endothelial damage and decrease in elastic function in early stage of OSAS. Meanwhile, CPAP can effectively improve vascular elasticity and endothelial function in patients.

【学位授予单位】：南京医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R56

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