呼吸睡眠暂停综合征对冠心病的影响

发布时间：2018-07-01 13:00

本文选题：呼吸睡眠暂停综合征 + 冠心病　；参考：《郑州大学》2012年硕士论文

【摘要】：背景冠心病(coronary heart disease, CHD)正逐步变成人类健康的头号杀手,研究影响CHD发病过程中可能影响到疾病发展的因素,对于CHD病情发展的早期干预有这重要的意义。阻塞性睡眠呼吸暂停综合征(Obstructive sleep apnea syndrome, OSAS)是由于某些原因而致上呼吸道阻塞,患者睡眠时有呼吸暂停,伴有缺氧、鼾声、白天嗜睡等症状的一种较复杂的疾病。OSAS往往会影响到人们的生活质量和心血管健康。研究认为OSAS常直接引起或诱发的心血管疾病包括冠心病,心力衰竭,高血压,心律失常和中风等,这都进一步增加了OSAS人群的发病率和死亡率。据调查有1/5的人群患有阻塞性睡眠呼吸暂停,而75%～80%的情况患者可以从治疗中获益,可以改善临床状态并能延缓疾病进展。有此可见明确OSAS与冠心病之间的关系意义重大。目前国外关于OSAS与冠心病之间的研究已有一些报道,证明其二者之间存在一定的关系,但国内对此的研究较少,并多局限于对国外理论性研究的总结。目的探讨OSAS患者AHI、ODI指标与冠状动脉病变程度之间的关系,以及不同程度的OSAS患者行PCI术后MACEs发生情况的对比。方法选择2010年11月至2011年8月以冠心病及胸痛查因为初诊诊断入郑州大学第一附属医院心内科的患者52名。入院后记录患者年龄、性别等一般病史资料,血液生化检查结果,行CAG检查获得患者冠脉病变程度。根据CAG检查结果将患者分为非冠心病组(14例)、单支病变组(13例)、双支病变组(11例)、三支病变组(14例),比较各组间各项生化指标水平。进一步对患者行PSG检测,根据检查结果将患者分为非OSAS组(12例)、轻度OSAS组(15例)、中度OSAS组(13例)、重度OSAS组(12例),比较各组AHI、ODI指标与冠状动脉病变程度之间的相关性,并通过平均201天的随访对患者PCI术后发生MACEs情况进行生存分析。结果 1、按照冠状动脉病变程度分组,四组患者在性别、年龄、吸烟、饮酒史以及甘油三酯、高密度脂蛋白等方面无明显统计学差异(p0.05),而在hs-CRP、总胆固醇、低密度脂蛋白等生化指标以及AHI、 ODI等方面多支病变明显高于简单病变及非冠心病组,差异有统计学意义(p0.05)。 2、冠心病组患者血清TC及LDL-C水平均高于非冠心病组患者,差异有显著统计学意义(p0.05),而冠心病各组之间即单支病变组、双支病变组及三支病变组之间患者比较无显著统计学意义(p0.05)；hs-CRP水平在冠心病组患者中明显高于非冠心病组患者,其差异有统计学意义(p0.05),在冠心病各组间比较该差异均具有统计学意义(p0.05)。 3、AHI、ODI与冠状动脉病变程度之间呈正相关关系,分别为(r=0.77,p0.01)、(r=0.76,p0.01)。 4、将患者以AHI=15为界限分组,两组患者PCI术后平均随访201天MACEs发生情况,PSG阳性组的术后MACE发生率明显高于PSG阴性组(26.1%vs6.7%：p=0.035) 结论 1、冠心病患者TC、LDL-C、hs-CRP等指标与冠状动脉严重程度密切相关。 2、冠心病患者AHI、ODI指标的高低在一定程度上同患者冠状动脉病变的严重程度呈相关性。 3、AHI较高的冠心病患者短期内出现PCI术后MACEs的可能性更大。
[Abstract]:background
Coronary heart disease (CHD) is gradually becoming the leading killer of human health. It is important to study the factors that may affect the development of the disease during the pathogenesis of CHD. It is of great significance for the early intervention of the development of CHD. The obstructive sleep apnea syndrome (Obstructive sleep apnea syndrome, OSAS) is due to some of the factors. A more complex disease,.OSAS, often affects people's quality of life and cardiovascular health. It is considered that OSAS often causes or induces cardiovascular diseases, including coronary heart disease, heart failure, hypertension, and heart loss. The incidence and mortality of the OSAS population are further increased. It is found that people with 1/5 have obstructive sleep apnea, and 75% to 80% of the patients can benefit from the treatment, which can improve the clinical status and delay the disease progression. It is clear that the relationship between OSAS and coronary heart disease is significant.
At present, there have been some reports on the study of OSAS and coronary heart disease, which prove that there is a certain relationship between them, but there are few studies in China, and it is limited to the summary of theoretical research abroad.
objective
Objective to investigate the relationship between AHI, ODI index and severity of coronary artery disease in OSAS patients, and compare the incidence of MACEs after PCI in different degree of OSAS patients.
Method
From November 2010 to August 2011, 52 patients in the Department of Cardiology, the First Affiliated Hospital of Zhengzhou University were diagnosed with coronary heart disease and chest pain in the First Affiliated Hospital of Zhengzhou University. After admission, the patients' age, sex and other general medical history data were recorded, the results of blood biochemical examination were recorded, and the degree of coronary artery disease was obtained by CAG examination. According to the results of CAG examination, the patients were divided into non crowns. 14 cases (14 cases), single branch lesion group (13 cases), three branch lesion group (14 cases), compared the level of biochemical indexes between each group. The patients were further examined by PSG. According to the results, the patients were divided into non OSAS group (12 cases), mild OSAS group (15 cases), moderate OSAS group (13 cases), severe OSAS group (12 cases), and AHI, ODI index and ODI index in each group. The correlation between the degree of coronary artery lesion and the survival rate of MACEs after PCI were analyzed by an average of 201 days follow-up.
Result
1, there were no significant differences in sex, age, smoking, drinking history, triglyceride and high density lipoprotein (P0.05) in the four groups according to the degree of coronary artery disease (P0.05), but in hs-CRP, total cholesterol, low density lipoprotein and other biochemical indexes, and AHI, ODI, and other diseases were significantly higher than those of simple lesions and non coronary heart disease groups. The difference was statistically significant (P0.05).
2, the levels of serum TC and LDL-C in patients with coronary heart disease were higher than those in non coronary heart disease group, the difference was statistically significant (P0.05), but there was no significant difference between the single branch lesion group, the double branch group and the three lesion group (P0.05), and the hs-CRP level in the coronary heart disease group was significantly higher than that of the non coronary heart disease group. The difference between the two groups was statistically significant (P0.05), and the difference was statistically significant in all coronary heart disease groups (P0.05).
3, there was a positive correlation between AHI, ODI and the severity of coronary artery disease (r=0.77, P0.01), (r=0.76, P0.01).
4, the patients were divided into AHI=15 groups. The average follow-up of the two groups after PCI was 201 days MACEs, and the incidence of MACE in the PSG positive group was significantly higher than that of the PSG negative group (26.1%vs6.7%:p=0.035).
conclusion
1, TC, LDL-C, hs-CRP and other indicators in patients with coronary heart disease are closely related to the severity of coronary artery disease.
2, the level of AHI and ODI in patients with coronary heart disease is correlated with the severity of coronary artery disease to some extent.
3, AHI patients with higher coronary heart disease are more likely to have MACEs after PCI in the short term.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R541.4;R56

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