阻塞性睡眠呼吸暂停综合征患者左室几何形态及其影响因素的临床研究

发布时间：2018-03-19 08:35

  本文选题：超声心动图　切入点：左室重构　出处：《山西医科大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的：探讨阻塞性睡眠呼吸暂停综合征(Obstructive Sleep Apnea Syndrome, OSAS)患者的左室重构(Left Ventricular Remodeling, LVR)类型及心血管危险因素对其构型的影响。 方法：因打鼾疑为OSAS入我院进行多导睡眠监测(Polysomnography, PSG)的患者共198例,并行24小时动态血压监测,记录夜间血压(nSBP, nDBP24:00、2：00、4：00)、晨起血压(mSBP, mDBP6:00、8:00)和白天血压(dSBP, dDBP22:00、12：00),一般资料(性别、年龄、身高、体重、颈围、腰围、臀围、吸烟史、饮酒史、高血压、糖尿病、临床症状及体征、家族史及工作性质等),于次日晨检测甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、血红蛋白(Hb)、血肌酐(SCr)、尿素氮(BUN)、空腹血糖(Fasting Glucose)。其中排除多导睡眠监测AHI5次/h者23例,原始数据资料不完整者11例,脑梗塞患者11例,先天胸廓畸形患者1例,手术治疗后复查无治疗前数据者4例,最终AHI≥5次/h的148例OSAS患者入选。次日晨进行超声心动图检查,测量舒张末期和收缩末期左室内径(LVDd和LVSd)、舒张末期室间隔和左室后壁厚度(IVST和LVPWT),计算相对室壁厚度(RWT)和左室质量指数(LVMI).根据RWT≥0.42和LVMI≥46.7g/m2.7(女)或49.2g/m27(男),将左室几何构型分为正常构型(Normal Geometry, NG),向心性重构(Concentric Remodeling, CR),离心性肥厚(Eccentric Hypertrophy, EH)和向心性肥厚(Concentric Hypertrophy,CH),并应用多变量logistic回归分析(Multinomial logistic regression)统计方法研究心血管危险因素与左室重构类型的相关性。 结果：1.148例OSAS患者,其中115例(77.7%)患者发生左室几何构型的改变,四种构型的比率分别为NG33例(22.3%),CR35例(23.6%),EH37例(25%)及CH43例(29.1%),其中向心性几何构型(52.7%)(包括CR与CH)所占比例高于EH(25%)。2.一般资料的特征：①与NG组比较,EH组BMI及腰围均升高,差异均有统计学意义(P0.01)；CH组年龄、BMI、腰围、高血压、dSBP mn及nSBP mn均升高,差异均有统计学意义(P0.05或P0.01)。②与CR组比较,EH组年龄、BMI及腰围均升高,差异均有统计学意义(P0.05或P＜0.01）；CH组性别、年龄、BMI、腰围、高血压、_nSBPmn及TG均升高，差异均有统计学意义（P＜0.05或P＜0.01）。③与EH组比较，CH组高血压发病率升高，差异有统计学意义（P＜0.05）。3.呼吸指标的特征：①与NG组比较，CR组AHI及ODI均升高，，差异均有统计学意义（P＜0.05或P＜0.01）；CH组AHI、ODI及T90均升高，而MeanSO_2及LowestSO_2均降低，差异均有统计学意义（P＜0.05或P＜0.01）。②与CR组比较，EH组AHI降低，差异有统计学意义（P＜0.05）；CH组MeanSO_2降低，而T90升高，差异均有统计学意义（P＜0.05或P＜0.01）。③与EH组比较，CH组LowestSO_2降低，差异有统计学意义（P＜0.05）。4.各点血压测量值的特征：①与NG组比较，CH组4:00SBP及6:00SBP均升高，差异均有统计学意义（P＜0.05）。②与CR组比较，CH组22:00SBP升高，差异有统计学意义（P＜0.05）。5.采用多变量Logistic回归分析统计方法，校正混杂因素的作用后（年龄、BMI、_dSBPmn、_nSBPmn、4:00SBP、6:00SBP、AHI、LowestSO_2、Mean SO_2、T90及ODI），CR与AHI相关（OR1.035，P=0.024），EH与年龄、BMI及4:00SBP相关（OR1.094，P=0.016）、（OR1.397，P=0.011）、（OR1.124，P=0.026），CH与年龄相关（OR1.084，P=0.028）。 结论：1.OSAS可引起LVR，且四种构型所占比率相类似。2.年龄、AHI分别为CH、CR的重要决定因素，年龄、BMI、4:00SBP是EH的重要决定因素。
[Abstract]:Objective: To investigate the effects of Left Ventricular Remodeling (LVR) and cardiovascular risk factors on the configuration of patients with Obstructive Sleep Apnea Syndrome (OSAS).
Methods: by snoring suspected OSAS in our hospital were monitored by polysomnography (Polysomnography, PSG) with a total of 198 cases, parallel 24 hour ambulatory blood pressure monitoring and recording of nocturnal blood pressure (nSBP, nDBP24:00,2:00,4:00), morning blood pressure (mSBP, mDBP6:00,8:00) and daytime blood pressure (dSBP, dDBP22:00,12:00), general data (sex, age, height, weight, neck circumference, waist circumference, hip circumference, smoking history, drinking history, hypertension, diabetes, clinical symptoms and signs, family history and the nature of the work, etc.) in the morning (TG), detection of triglyceride total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein the cholesterol (LDL-C), hemoglobin (Hb), serum creatinine (SCr), urea nitrogen (BUN), fasting blood glucose (Fasting Glucose). 23 cases were excluded polysomnography AHI5 times of /h, 11 cases of the original data is not complete, 11 cases of patients with cerebral infarction, 1 patients with congenital malformation of the chest hand. 4 patients after treatment was no data before treatment, 148 patients with OSAS were more than 5 times the final AHI /h. The following morning echocardiography measured left ventricular end diastolic and end systolic diameter (LVDd and LVSd), interventricular septum and left ventricular posterior wall thickness (IVST and LVPWT). The calculation of relative wall thickness (RWT) and left ventricular mass index (LVMI). According to RWT = 0.42 and LVMI = 46.7g/m2.7 (female) or 49.2g/m27 (male), the left ventricular geometry divided into normal geometry (Normal Geometry, NG), concentric remodeling (Concentric Remodeling, CR) and eccentric hypertrophy (Eccentric Hypertrophy, EH) and concentric hypertrophy (Concentric Hypertrophy, CH), and the application of multivariate logistic regression analysis (Multinomial logistic regression) the correlation between risk factors and cardiovascular research statistical methods left ventricular remodeling type.
缁撴灉锛

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