持续气道正压通气对阻塞性睡眠呼吸暂停综合征患者血浆脂类水平影响的系统评价

发布时间：2018-05-09 00:40

本文选题：阻塞性睡眠呼吸暂停综合征 + 持续气道正压通气　；参考：《山东大学》2012年硕士论文

【摘要】：目的系统评价持续气道正压通气(CPAP)治疗阻塞性睡眠呼吸暂停综合征(OSAS)在改善血脂水平方面疗效。方法计算机检索PubMed, Embase, Springer Link, CNKI,万方数据库和google学术搜索引擎2000.01-2011.12公开发表的CPAP治疗OSAS患者血浆脂类水平影响的随机对照试验(RCT)及非随机对照研究,并查找相关会议文献及询问本领域专家获取资料；并按纳入排除标准独立筛选试验、提取资料和评价方法学质量,而后采用RevMan5.0软件进行Meta分析。结果共纳入14项研究(见表1)。 1.CPAP治疗前后的各指标的结果：CPAP治疗后TC值降低明显[WMD=0.1968,95%CI(0.0752,0.3184)]；TG较前无明显降低,Z=0.65(P=0.51),[WMD=0.0375,95%CI(0.0752,0.3184)]；HDL较治疗前升高不明显,Z=1.28(P=0.20),[WMD=0.0498,95%CI(-0.1263,0.0267)]；LDL值较前降低明显[WMD=0.1847,95%CI(0.0481,0.3213)]。 2.平行试验中各指标的结果：CPAP治疗后治疗组TC值降低明显[WMD=-0.18,95%CI(-0.37,0.00)]；TG较前无明显降低,Z=0.05(P=0.96),[WMD=0.00,95%CI(-0.13,0.13)]；HDL较治疗前升高不明显,Z=1.23(P=0.22),[WMD=0.04,95%CI(-0.03,0.11)]；LDL值较前降低明显[WMD=-0.22,95%CI(-0.43,-0.01)]。 3.交叉试验中各指标的结果：CPAP治疗后治疗组TC值降低明显[WMD=-0.25,95%CI(-0.42,-0.09)]；TG较前明显降低,[WMD=-0.19,95%CI(-0.40,0.03)]；HDL较治疗前变化不明显,Z=1.01(P=0.31),[WMD=-0.03,95%CI(-0.08,0.03)]；LDL值较前降低不明显,Z=1.10(P=0.27),[WMD=-0.10,95%CI(-0.27,-0.08)]。结论本研究提示CPAP作为针对中重度OSAS患者的首选治疗方法,在消除呼吸暂停、低通气、鼾声和呼吸努力相关微觉醒,改善睡眠状态的同时,可调节血脂代谢,纠正患者的脂类代谢的紊乱,明显降低TC水平。CPAP对TG、HDL、LDL等水平的影响尚待临床进一步证实。
[Abstract]:Purpose

To evaluate the efficacy of continuous positive airway pressure ventilation ( CPAP ) in the treatment of obstructive sleep apnea syndrome ( obstructive sleep apnea syndrome ) in the improvement of blood lipid levels .

method

Computers were searched for randomized controlled trials ( RCTs ) and non - randomized controlled studies of the effects of CPAP on plasma lipid levels in patients with obstructive sleep apnea , published by the published CPAP , Embase , Springer Link , CNKI , Wanfang database , and Google Academic Search Engine , 2000 . 01 - 2011 . 12 .
The independent screening test , extraction data and evaluation methodology quality were carried out according to the exclusion criteria , and the meta - analysis was carried out using the RevMan5.0 software .

Results

A total of 14 studies were included ( see table 1 ) .

1 . Results of the indexes before and after CPAP : the decrease of TC value after CPAP therapy decreased significantly ( WMD = 0 . 1968 , 95 % CI ( 0 . 0752 , 0 . 3184 ) ;
There was no significant decrease in TG , Z = 0.65 ( P = 0.51 ) , WMD = 0.0375 , 95 % CI ( 0.052 , 0.3184 ) ;
HDL was not significantly higher before treatment , Z = 1.28 ( P = 0.20 ) , WMD = 0.098 , 95 % CI ( - 0.1263 , 0.0267 ) ;
LDL value was significantly lower than that before , WMD = 0 . 1847 , 95 % CI ( 0 . 0481 , 0 . 3213 ) .

2 . Results of each index in the parallel test : the TC value of the treatment group after CPAP decreased significantly ( WMD = - 0.18 , 95 % CI ( - 0.37 , 0.00 ) ;
There was no significant decrease in TG , Z = 0.05 ( P = 0.96 ) , WMD = 0.00 , 95 % CI ( - 0.13 , 0.13 ) ;
HDL was not significantly higher before treatment , Z = 1.23 ( P = 0.22 ) , WMD = 0.04 , 95 % CI ( - 0.03 , 0.11 ) ;
LDL value was significantly higher than that before , WMD = - 0.22 , 95 % CI ( - 0.43 , - 0.01 ) .

3 . Results : TC value of treatment group decreased significantly after CPAP treatment , WMD = - 0.25 , 95 % CI ( - 0.42 , - 0.09 ) ;
TG was significantly lower than that before , WMD = - 0.19 , 95 % CI ( - 0.40 , 0.03 ) ;
HDL was not significant before treatment , Z = 1.01 ( P = 0.31 ) , WMD = - 0.03 , 95 % CI ( - 0.08 , 0.03 ) ;
LDL was not significantly lower than before , Z = 1.10 ( P = 0.27 ) , WMD = - 0.10 , 95 % CI ( - 0.27 , - 0.08 ) .

Conclusion

The present study suggested CPAP as the preferred treatment method for patients with moderate and severe obstructive sleep apnea syndrome . The effects of CPAP on the levels of TG , HDL , LDL and so on in patients with moderate and severe obstructive sleep apnea , hypoventilation , snoring and respiratory effort can be adjusted , and the level of TC can be significantly reduced . The effects of CPAP on TG , HDL , LDL and so on are still to be confirmed clinically .

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R766.4

【参考文献】