阻塞性睡眠呼吸暂停低通气综合征患者甲状腺激素水平的研究

发布时间：2018-03-05 21:26

本文选题：阻塞性睡眠呼吸暂停低通气综合征　切入点：甲状腺激素水平　出处：《福建医科大学》2010年硕士论文　论文类型：学位论文

【摘要】： 目的研究甲状腺激素在阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)中的变化,并进一步探讨甲状腺激素水平的变化在OSAHS的发生、发展及并发症中的意义,为寻找防治OSAHS并发症的途径提供思路。方法实验1.连续入选因打鼾在我院经多导睡眠仪行夜间7小时睡眠监测患者116例,夜间行多导睡眠呼吸监测,清晨抽取静脉血用放射免疫分析法检测血浆FT3、FT4、sTSH浓度,采用Olympus2700全自动生化分析仪测定血脂及血糖,依据多导睡眠监测结果,采用两种不同的分组方法分组如下:1.依据患者病情轻重(即AHI水平)分为:20例单纯鼾症组、28例轻度OSAHS组、34例中度OSAHS组、34例重度OSAHS组;2、依据患者缺氧程度不同(即最低血氧饱和度水平)分为:无明显缺氧组21例、轻度缺氧组43例、中度缺氧组30例、重度缺氧组22例。对比各实验组患者间FT3、FT4、sTSH浓度的差异以及不同指标间的相关性。实验2.开展干预实验,对OSAHS组并缺氧患者予以经鼻持续气道正压通气(nasal continuous positive air pressure,nCPAP)治疗并随访3个月,共有90例患者接受nCPAP治疗,依据随访时间的先后连续入选30例经nCPAP治疗满3个月者,其中治疗之前诊断轻度缺氧患者7例、中度缺氧患者12例、重度缺氧患者11例,比较两组患者治疗前后的主要睡眠参数、FT3、FT4、sTSH浓度变化。运用SPSS11.5统计软件进行分析。计量资料采用单因素方差分析及协方差分析,计数资料采用R×C表χ2检验,两因素相关性研究采用Pearson相关系数进行直线回归分析,并采用多元回归分析法进行预测因子的评价,治疗前后比较用配对t检验。P0.05为差异有统计学意义。结果 1、不同病情组:①不同病情组FT4浓度值差异有统计学意义,但两两比较显示仅重度OSAHS组明显低于单纯鼾症组、轻度OSAHS组及中度OSAHS组且差别有显著意义,单纯鼾症组、轻度OSAHS组及中度OSAHS组之间差别无统计学意义。②FT3、sTSH浓度值各组间差别无统计学意义,两两比较各组间差别亦无统计学意义。2、不同缺氧程度组:①伴随末梢氧浓度降低FT4浓度值逐渐降低且差异有统计学意义,两两比较各组间均有差别且有统计学意义。②FT3、sTSH浓度值各组间差别无统计学意义,两两比较各组间差别亦无统计学意义。 3、Pearson相关系分析显示:FT4浓度与最低血氧浓度呈正相关(r= 0.899、P0.01),与氧减指数、TS90%(血氧小于90%的时间)、嗜睡评分呈负相关(r=-0.861 ,P0.01;r=-0.821 ,P0.01;r=-0.759 ),与TCHO、TG、VLDL、空腹血糖相关系数分别为:(r=-0.183 ,P0.05,r=-0.372 ,P0.05;r=-0.476 ,P0.01; r=-0.145 ,P0.05),FT3、sTSH与以上指标无明显相关性。 4.多元回归分析显示最低血氧浓度X1、氧减指数X2、嗜睡评分X3及睡眠呼吸暂停低通气时间指数(AHTI) X4为FT4水平的预测因素,t值分别为6.004(P0.01)、-5.022 (P0.01)、-3.386(P0.05)、-1.988 (P0.05)。多元回归方程为:FT4=-2.286+0.275X1-0.084X2-0.16X3-0.023X4。 5.30例OSAHS患者经nCPAP治疗3个月后,患者FT4水平明显升高且差别有统计学意义, FT3、sTSH治疗前后则无明显变化。结论: 1.重度OSAHS组甲状腺激素水平明显高于单纯鼾症组及轻、中度OSAHS组,提示睡眠呼吸暂停低通气综合症发展到一定程度可能引起甲状腺激素水平变化。 2.缺氧越严重FT4水平越低,提示睡眠呼吸暂停低通气所致的间断性缺氧可能是导致睡眠呼吸暂停患者甲状腺激素水平变化的重要因素。 3.FT4水平变化与最低血氧饱和度、氧减指数、TS90%、嗜睡评分成直线相关,提示甲状腺激素水平的变化不仅与缺氧的程度有关,而且与间断缺氧的频率、缺氧的时间密切相关,并且提示甲状腺激素水平下降可能与睡眠呼吸暂停患者的白天过度嗜睡等临床表现有关,FT4水平与TCHO、TG、VLDL、空腹血糖等指标密切相关提示甲状腺激素水平的变化可能为OSAHS患者的血脂、血糖异常等并发症的重要影响因素。 4.经nCPAP治疗后,患者FT4水平明显升高,提示nCPAP治疗可以纠正OSAHS患者甲状腺激素水平,从而改善临床症状,预防或缓解睡眠呼吸暂停综合征患者并发症的发生、发展。
[Abstract]:objective
Study of thyroid hormone in obstructive sleep apnea hypopnea syndrome (obstructive sleep apnea-hypopnea syndrome, OSAHS) in the changes, and to further explore the changes of thyroid hormone level in OSAHS occurrence, development and clinical significance, to provide ideas for ways to prevention and treatment of OSAHS complications.
Method
Experiment 1. consecutive snoring by polysomnography for 7 hours a night sleep monitoring of patients with 116 cases in our hospital, night polysomnography, morning venous blood by radioimmunoassay to detect plasma FT3, FT4, sTSH concentration, using Olympus2700 automatic biochemical analyzer for determination of blood lipid and blood sugar, according to the sleep monitoring results, by grouping two different grouping methods are as follows: 1. according to the severity of disease (i.e. AHI) is divided into: 20 patients with simple snoring group, 28 cases of mild OSAHS group, moderate OSAHS group 34 cases, 34 cases of severe OSAHS group; 2 patients, according to different degree of hypoxia (i.e. the lowest oxygen the saturation level) is divided into: no obvious hypoxia group 21 cases, 43 cases of mild hypoxia group, moderate hypoxia group 30 cases, 22 cases of severe hypoxia group. The patients in the experimental group compared to FT3, FT4, and sTSH concentration differences between different indicators of relevance.
Experiment 2. carried out intervention experiment, OSAHS group and hypoxia treated with nasal continuous positive airway pressure (nasal continuous positive air pressure, nCPAP) treatment and follow-up of 3 months, a total of 90 patients received nCPAP treatment, on the basis of follow-up time sequence of 30 consecutive patients treated with nCPAP for 3 months, which the treatment before the diagnosis of 7 cases of patients with mild hypoxia, 12 cases of patients with moderate hypoxia, severe hypoxia in patients with 11 cases, the main sleep parameters, two groups were compared before and after treatment of FT3, FT4, sTSH concentration.
The data was analyzed by using SPSS11.5 software. The measurement data using single factor analysis of variance and covariance analysis, count data using R * C Table 2 test, study the correlation between the two factors using the Pearson correlation coefficient of linear regression analysis, and analysis the evaluation of predictors by multivariate regression, before and after treatment was compared with paired t test for difference.P0.05 there was statistical significance.
Result
1 different disease groups: different disease group FT4 concentration difference was statistically significant, but the 22 shows only severe OSAHS group was significantly lower than that in simple snoring group, significant mild OSAHS group and moderate group OSAHS and the difference between Dan Chunhan's disease group, mild OSAHS group and moderate OSAHS groups had no significant difference. FT3, sTSH concentration between the groups there was no significant difference between the 22 groups were compared, the difference was not statistically significant.2, different degree of hypoxia groups associated with peripheral oxygen concentration and decrease the concentration of FT4 decreased and the difference was statistically significant, the 22 groups were different and the difference was statistically significant. The FT3 value of sTSH concentration between groups there was no significant difference between the 22 groups were compared, the difference was not statistically significant.
3, analysis of Pearson correlation showed that FT4 concentration correlated with the lowest oxygen concentration (r= 0.899, P0.01), and TS90% (oxygen desaturation index, less than 90% of the time), sleepiness score was negatively correlated (r=-0.861, P0.01; r=-0.821, P0.01; r=-0.759), and TCHO, TG, VLDL, fasting glucose the coefficient were: (r=-0.183, P0.05, r=-0.372, P0.05; r=-0.476, P0.01; r=-0.145, P0.05, FT3), there was no correlation between sTSH and the above indexes.
4. multivariate regression analysis showed the lowest oxygen concentration X1, oxygen desaturation index X2, X3 sleepiness score and sleep apnea hypopnea index (AHTI) time X4 predictive factors for FT4 levels, t values were 6.004 (P0.01), -5.022 (P0.01), -3.386 (P0.05), -1.988 (P0.05) multiple regression equation. For: FT4=-2.286+0.275X1-0.084X2-0.16X3-0.023X4.
5.30 cases of OSAHS patients were treated with nCPAP for 3 months, and the level of FT4 was significantly higher and the difference was statistically significant. There was no significant change before and after the treatment of sTSH.
Conclusion:
1., the thyroid hormone level in severe OSAHS group was significantly higher than that in simple snoring group and mild or moderate OSAHS group, suggesting that the development of sleep apnea hypopnea syndrome may lead to a change in thyroid hormone level.
2., the more severe anoxia is, the lower the level of FT4. It suggests that intermittent hypoxia induced by sleep apnea hypopnea may be an important factor leading to the change of thyroid hormone level in patients with sleep apnea.
The change of 3.FT4 level and the lowest oxygen saturation, oxygen desaturation index, TS90% sleepiness score, a linear correlation, suggests that the changes of thyroid hormone level is not only related to the degree of hypoxia, and the frequency of intermittent hypoxia, hypoxia is closely related to the time, and suggest that thyroid hormone level may be decreased in patients with sleep apnea and excessive daytime sleepiness. The clinical manifestations, FT4 level and TCHO, TG, VLDL, fasting blood glucose and other indicators may change that closely related to thyroid hormone levels of blood lipids in patients with OSAHS, important factors of abnormal blood glucose and other complications.
4. after nCPAP treatment, the FT4 level of patients increased significantly, suggesting that nCPAP therapy can correct thyroid hormone levels in OSAHS patients, thereby improving clinical symptoms, preventing or alleviating the occurrence and development of complications in patients with sleep apnea syndrome.

【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R766

【参考文献】