COPD-OSA重叠综合征的临床特征

发布时间：2018-08-14 18:53

【摘要】：目的:通过对单纯COPD、单纯OSA及OS患者肺功能、血气分析、多导睡眠监测等各项指标的比较,分析三组患者之间的差异,明确COPD合并OSA对患者的危害,比较不同严重程度、不同病程的OS之间的区别。对象和方法:采用回顾性病例对照研究方法,采集2010年1月-2016年10月在吉林大学第一医院呼吸内科确诊为单纯COPD、单纯OSA及OS的患者的临床资料,共70例。按照呼吸暂停低通气指数(apnea hypopnea index,AHI)及肺功能各项指标将其分为COPD组27例,OSA组21例,OS组22例,采集入选对象的临床资料,统计单纯OSA组、单纯COPD组及OS组的性别、年龄、病程、体重指数(body mass index,BMI)、肺功能各项参数、多导睡眠监测(polysomnography,PSG)的各项指标以及血气分析的结果,比较三组间一般情况、肺功能参数、多导睡眠监测及血气分析和不同严重程度、不同病程的OS患者之间的区别及COPD患者合并OSA的危险因素。结果:1、OS组年龄明显高于OSA组(P=0.000)。2、吸烟史:OS组(68.2%)较COPD组(33.3%)多(P=0.015),糖尿病史:OS组(40.9%)较COPD组(7.4%)多(P=0.005),单纯OSA组(38.1%)较单纯COPD组(7.4%)多(P=0.009)。心脑血管病史:OS组(50.0%)较单纯COPD组(14.8%)多(P=0.009)。OS组BMI明显高于OSA组及COPD组(P=0.000)。3、各组肺功能比较,OS组、单纯COPD组与单纯OSA组相比较FEV1%pred、FEV1/FVC明显降低(P=0.000)。4、OS组AHI较单纯COPD组、单纯OSA相比升高(P=0.000),OS组LSa O2较单纯COPD组、单纯OSA相比降低(P=0.000)。OS组夜间最长氧减时间较单纯COPD组、单纯OSA相比升高(P=0.000)。5、随着病情的加重,OS患者AHI、BMI逐渐增高,而夜间最低血氧饱和度逐渐下降,肺功能损害更加严重,且AHI与BMI呈正相关(r=0.858,P=0.000),AHI与LSa O2呈负相关(r=-0.686,P=0.000)。6、随着病程的延长,OS患者AHI逐渐增高,肺功能损害更加严重。7、COPD合并OSA的危险因素为BMI,OSA合并COPD危险因素为年龄。结论:1、OS患者较OSA患者肺通气功能损害严重,且较COPD患者及OSA患者更易合并夜间低氧血症及高碳酸血症。2、COPD患者BMI越大越容易合并OSA,OSA患者年龄越大越容易合并COPD。
[Abstract]:Objective: To analyze the differences among the three groups by comparing the pulmonary function, blood gas analysis and polysomnography in patients with COPD, OSA and OS, to clarify the harm of COPD combined with OSA to the patients, and to compare the differences between OS with different severity and course of disease.Objectives and Methods: A retrospective case-control study was used. The clinical data of 70 patients with COPD, OSA and OS were collected from January 2010 to October 2016 in the Department of Respiratory Medicine of the First Hospital of Jilin University. According to apnea hypopnea index (AHI) and pulmonary function, they were divided into COPD group (27 cases), OSA group (21 cases) and OS group (22 cases). Material: Sex, age, course of disease, body mass index (BMI), lung function parameters, polysomnography (PSG) and blood gas analysis results of OSA group, COPD group and OS group were statistically analyzed. Results: 1. OS group was significantly older than OSA group (P = 0.000). 2. Smoking history: OS group (68.2%) was more than COPD group (33.3%). Diabetes history: OS group (40.9%) was more than COPD group (7.4%). Simple OSA group (38.1%) was more than COPD group (7.4%). History of vascular disease: OS group (50.0%) was more than COPD group (14.8%) (P = 0.009). BMI of OS group was significantly higher than OSA group and COPD group (P = 0.000). Compared with COPD group, lung function of OS group, COPD group, COPD group and OSA group were significantly lower than FEV1% pred, FEV1 / FVC (P = 0.000). 4, AHI of OS group was higher than COPD group (P = 0.000), and LSa O2 of OS group was significantly lower than COPD group. The longest time of oxygen loss in OS group was higher than that in COPD group (P = 0.000). With the aggravation of the disease, the AHI and BMI of OS patients increased gradually, while the lowest blood oxygen saturation decreased gradually, and the lung function damage was more serious. AHI was positively correlated with BMI (r = 0.858, P = 0.000), AHI was negatively correlated with LSa O2 (P = 0.000). R = - 0.686, P = 0.000). 6. As the course of disease prolonged, the AHI of OS patients increased gradually, and the pulmonary function impairment became more serious. 7. The risk factors of COPD complicated with OSA were BMI, OSA complicated with COPD were age. Conclusion: 1. OS patients had more severe impairment of pulmonary ventilation function than OSA patients and COPD patients and OSA patients were more likely to have nocturnal hypoxemia and hypercapnia. .2, COPD patients, the greater the BMI, the easier to merge OSA. The older the OSA, the easier it is to merge COPD..
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.9;R766

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