阻塞性睡眠呼吸暂停低通气综合征与冠心病血管病变及血清学的关系

摘要

目的 探讨冠心病合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血管病变及血清学的关系.方法 将168例入组患者根据呼吸暂停低通气指数(AHI)分成3组:轻度组(AHI,5~14/h)60例、中度组(AHI,15~30/h)60例、重度组(AHI>30/h)48例.根据冠状动脉造影结果 对各组进行Syntax评分,并对各组的血红蛋白(Hb)、血小板计数(PLT)、纤维蛋白原定量(FIB)、D-二聚体(DD)、总胆固醇(TC)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、三酰甘油(TG)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、尿酸(UA)、肌酐(Cr)及超声心动图的检查指标行统计学分析.结果 重度组Syntax积分明显高于轻、中度组(P<0.05),但轻、中度组间差异无统计学意义.轻、中度组的Hb、FIB、LDL、肺动脉压(PAP)、右室前后径(RVD)均低于重度组(P<0.01),重度组的左室射血分数(LVEF)低于轻中度组(P<0.01).而轻度组、中度组之间的Hb、FIB、LDL、PAP、RVD和LVEF差异均无统计学意义(P>0.05).结论 重度OSAHS患者不仅血清学和心脏结构会逐渐改变,而且冠状动脉病变会更加复杂,因此临床上对于冠心病患者应注意筛查OSAHS疾患并且积极采取治疗措施.%Objective To investigate the relationship between vascular lesion and serological changes in patients with coronary heart disease (CHD) complicated with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods According to the standard, a total of 168 patients of OSAHS complicated with CHD were selected in this study. Those patients were divided into 3 groups according to the apnea hypopnea index (AHI) level:light group (AHI, 5-14/h), moderate group (AHI, 15-30/h) and severe group (AHI,>30/h). Syntax scores were performed on three groups according to coronary angiography results. The data of hemoglobin (Hb), platelet count (PLT), fibrinogen (FIB), D-Dimer (DD), total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL), triacylglycerol (TG), alanine aminotransferase (ALT), aspartate transaminase (AST), uric acid (UA), creatinine (Cr) and echocardiographic examination index were collected and analyzed in three groups. Results The Syntax score was significantly higher in severe group than that in mild and moderate groups (P<0.05). There was no significant difference in the Syntax score between mild and moderate groups. The levels of Hb, FIB, LDL, pulmonary arterial pressure (PAP), and right ventricle transverse diameter (RVD) were significantly lower in the mild and moderate groups than those in the severe group (P<0.01). The left ventricular ejection fraction (LVEF) was significantly lower in the severe group than that in the mild and moderate groups (P < 0.01). There were no significant differences in levels of Hb, FIB, LDL, PAP, RVD and LVEF between mild group and moderate group (P > 0.05). Conclusion The serology and cardiac structure can change gradually in severe OSAHS patients, and the coronary artery lesion will be more complex. Therefore, the clinical treatment should pay attention to screening for OSAHS in patients with coronary heart disease.