睡眠呼吸暂停综合症对C-反应蛋白、左房及房性早搏的影响

摘要

目的 评估血清C-反应蛋白(CRP)的浓度、左房大小和房性早搏与睡眠呼吸暂停综合症(OSAS)的关系.方法 经多导睡眠呼吸监测诊断为OSAS的277名患者行24 h动态心电图和动态血压检查.将发现有房性早搏的137名患者根据呼吸暂停低通气指数(AHI)分成3组,即轻度组(5＜AHI＜15),中度组(15≤AHI＜30)和重度组(AHI≥30).比较3组患者的血清CRP浓度、左房直径,分析二者与OSAS严重程度之间的关系.结果 OSAS患者中,房性早搏的发生率较高,为49.4%(134/277).轻、中、重度OSAS患者的CRP值分别为(2.98±1.82)mg/L,(3.03±1.94)mg/L,(5.01±4.68)mg/L,左房直径分别为(33.7±3.8)mm,(37.9±5.5)mm,(40.1±7.9)mm.血清CRP水平和左房自径与OSAS的严重程度成正相关(r=0.304,P=0.034;r=0.411,P=0.003).在排除性别、年龄和体质量指数的影响下,CRP和左房自径也呈正相关(r=0.594,P=0.0005).结论 OSAS患者房性早搏的发病率较高.在这些患有房性早搏的OSAS患者中,CRP水平和左房自径的大小与OSAS的严重程度成正相关的关系,提示炎症激活介导的左房重构和电重构可能在OSAS患者房性早搏的发生中起重要作用.%Objective To assess the changes of serum C-reactive protein (CRP) level, left atrial size and atrial premature contraction (PAC) in patients with obstructive sleep apnea syndrome (OSAS). Methods This study involved 277 patients with OSAS diagnosed after an overnight polysomnography, who underwent a 24-h Holter electrocardiography and ambulatory blood pressure monitoring for detection of PAC. According to the apnea-hypopnea index (AHI), 137 patients with PAC identified from these patients were classified into 3 groups, namely the mild (5≥AHI＜15), moderate (15 ≥AHI＜30) and severe (AHI≥30) groups. Serum CRP level was assessed by a high-sensitivity radio-immunoassay. The left atrial diameter and echocardiographic parameters were recorded by transthoracic Doppler echocardiography (TTE). Results We found a high prevalence of PAC in these OSAS patients (137/277,49.4%). Serum CRP was significantly higher in severe OSAS group (5.01 ±4.68 mg/L) than in the moderate (3.03±1.94 mg/L) and mild OSAS (2.98±1.82 mg/L) groups (P=0.040 and 0.033, respectively). The left atrial diameter was significantly increased in severe OSAS group (40.1±7.9 mm) as compared to that in moderate (37.9±5.5 mm) and mild (33.7±3.8 mm) groups (P=0.025 and 0.002,respectively). The severity of OSAS was positively correlated to both CRP (r=0.304, P=0.034) and left atrial diameter (r=0.411, P=0.003). After adjusting for gender, age and body mass index (BMI), a strong correlation was found between the left atrial diameter and CRP (r=0.594, P=0.0005). Conclusion There is a high prevalence of PAC in OSAS patients. The progression of OSAS is associated with increased serum CRP level and left atrial size in patients with premature atrial complexes. Our study suggests that inflammation associated with OSAS might contribute to atrial structural and electrical remodeling in OSAS patients with PAC.