摘要：
To evaluate right atrial ( RA ) structure and function of different left ventricular geometry in patients with obstructive sleep apnea syndrome ( OSAS ) by real‐time three‐dimensional echocardiography ( RT‐3DE) . Methods One hundred and ninety‐nine patients with habitual snoring were diagnosed as OSAS by polysomnography with apnea hypopnea index ≥ 5/h . Fifty gender ,age matching healthy people were selected as control group . Blood pressure and general clinical characteristics were collected and echocardiography was performed next morning . On the basis of left ventricular mass index , relative wall thickness ,left ventricular end‐diastolic diameter ,patients were divided into 6 groups :normal geometry ( NG) ,concentric remodeling ( CR) ,eccentric non dilated hypertrophy ( ND‐EH ) ,concentric non dilated hypertrophy ( ND‐CH ) ,eccentric dilated hypertrophy ( D‐EH ) ,and concentric dilated hypertrophy ( D‐CH) .Full volume images at apical four‐chamber view were collected . Right atrial volume‐time curve , RA maximum volume ( RAVmax ) , RA minimum volume ( RAVmin ) , RA pre‐contraction volume ( RAVpre‐a) were analyzed with QLab workstation . Following parameters including RA total emptying volume ( RA TotEV ) , RA total emptying fraction ( RA TotEF ) , RA passive emptying volume ( RA PassEV ) ,RA passive emptying fraction ( RA PassEF) ,RA active emptying volume ( RA ActEV ) ,RA active emptying fraction ( RA ActEF) were calculated . All structural parameters were corrected by BSA . Results①RA structural parameters :compared with control and NG groups ,RAVmax ,RAVmin ,RAVmin/BSA , RAVpre‐a and RAVpre‐a/BSA were increased in ND‐EH ,ND‐CH and D‐( CH+ EH) groups ( P ＜0 .05) . Compared with control ,NG and CR groups ,RAVpre‐a and RAVpre‐a/BSA were increased in ND‐EH ,ND‐CH and D‐( CH + EH ) groups , RAVmax , RAVmax/BSA , RAVmin , RAVmin/BSA , RAVpre‐a and RAVpre‐a/BSA were increased in ND‐CH and D‐( CH+EH ) groups( P ＜0 .05) . Compared with control , NG ,CR and ND‐EH groups ,RAVmax ,RAVmax/BSA ,RAVpre‐a and RAVpre‐a/BSA were increased in ND‐CH ,D‐( CH+EH) groups ,RAVmin and RAVmin/BSA were increased in D‐( CH+ EH ) group ( P ＜0 .05) . Compared with control ,NG ,CR ,ND‐EH and ND‐CH groups ,RAVpre‐a and RAVpre‐a/BSA were increased in D‐( CH + EH ) group ( P ＜ 0 .05 ) . ② RA reservoir function parameters :compared with control ,NG and CR groups ,RA TotEV was increased in ND‐CH and D‐( CH+ EH ) groups ( P ＜0 .05 ) . Compared with control ,NG ,CR and ND‐EH groups ,RA TotEV was increased in D‐( CH + EH ) group ( P＜0 .05) . ③ RA conduit function parameters :compared with control ,NG and CR groups ,RA PassEF was decreased in ND‐EH ,ND‐CH and D‐( CH + EH ) groups ,RA PassEV was decreased in ND‐CH and D‐( CH+EH) groups( P ＜0 .05) . Compared with control ,NG ,CR and ND‐EH groups ,RA PassEV was decreased in D‐( CH+EH) group ,RA PassEF was decreased in ND‐CH and D‐( CH+ EH ) groups ( P ＜0 .05) . ④ RA pump function parameters :compared with control ,NG and CR groups ,RA ActEF were increased in ND‐CH and D‐( CH+EH) groups ( P ＜0 .05 ) ; Compared with control ,NG ,CR and ND‐EH groups ,RA ActEV was increased in ND‐CH and D‐( CH+EH) groups ( P ＜0 .05) . Conclusions Different left ventricular geometric patterns have different RA structure and function in OSAS ,patients with ND‐CH and D‐( CH + EH ) have worse RA structure and function . T he results of this study suggested that the clinical need to pay attention to the RA structure and function of OSAS patients with dilated LV H .%目的 应用实时三维超声心动图(RT‐3DE )技术评价阻塞性睡眠呼吸暂停综合征(OSAS )患者6种左室构型的右房结构和功能.方法 经多导睡眠呼吸仪监测呼吸暂停指数≥5次／h确诊为OSAS的患者199例,次日晨行血压、血糖、血脂及超声心动图检查,同时选取性别、年龄匹配的健康志愿者50例作为对照组. OSAS患者依据左室质量指数、相对室壁厚度和左室舒末内径分为6组:正常构型(NG)组、向心性重构(CR)组、非扩张性离心性肥厚(ND‐EH)组、非扩张性向心性肥厚(ND‐CH)组、扩张性离心性肥厚(D‐EH)组和扩张性向心性肥厚(D‐CH)组. D‐EH和D‐CH组例数较少,为进一步统计分析,将二者合并为一组[D‐(CH+ EG)组] .采集心脏全容积图像, QLab软件脱机分析,获取右心房容积－时间曲线,得到右房最大容积(RAVmax)、右房最小容积(RAVmin)、右房收缩前容积(RAVpre‐a) ,计算右房功能参数:右房总排空容积(RA TotEV ) 、总排空分数(RA TotEF) 、被动排空容积(RA PassEV ) 、被动排空分数(RA PassEF ) 、主动排空容积(RA ActEV ) ,主动排空分数(RA ActEF) ,比较组间右房结构和功能参数的差异,并以体表面积(BSA )矫正.结果①右房结构参数:与对照组、 NG 组相比, ND‐EH 组、 ND‐CH 组、 D‐( CH + EH )组的 RAVmax 、RAVmin 、 RAVmin／BSA 、 RAVpre‐a 、 RAVpre‐a／BSA 增加, ND‐CH 、 D‐( CH + EH )组的 RAVmax／BSA增加( P ＜ 0 .05) ;与对照组、 NG组、 CR组相比, ND‐EH组、 ND‐CH组、 D‐( CH+ EH)组的RAVpre‐a 、 RAVpre‐a／BSA 增 加, ND‐CH 组、 D‐( CH + EH ) 组 的 RAVmax 、 RAVmax／BSA 、RAVmin 、 RAVmin／BSA 、 RAVpre‐a 、 RAVpre‐a／BSA增加( P ＜0 .05 ) ;与对照组、 NG组、 CR组、ND‐EH组相比, ND‐CH 组、 D‐( CH + EH )组的 RAVmax 、 RAVmax／BSA 、 RAVpre‐a 、 RAVpre‐a／BSA增加,D‐( CH+EH)组的RAVmin 、 RAVmin／BSA增加( P ＜0 .05) ;与对照组、 NG组、 CR组、ND‐EH组、 ND‐CH组相比,D‐( CH+EH)组的RAVpre‐a 、 RAVpre‐a／BSA增加(P＜0 .05) .②右房储蓄功能参数:与对照组、 NG组和CR组相比, ND‐CH组和D‐( CH+ EH )组的RA TotEV增加( P ＜0 .05) ;与对照组、 NG组、 CR组、 ND‐EH组相比, D‐( CH+ EH)组的RA TotEV增加( P ＜0 .05) .③右房管道功能参数:与对照组、 NG 组、 CR组相比, ND‐EH 、 ND‐CH 和 D‐( CH + EH )组的 RA PassEF减低, ND‐CH和D‐(CH+EH)组的RA PassEV减低( P ＜0 .05) ;与对照组、 NG组、 CR组、ND‐EH组相比, D‐( CH+ EH)组的 RA PassEV 减低, ND‐CH和D‐( CH+ EH)组的 RA PassEF减低( P ＜0 .05) .④右房助力泵功能参数:与对照组、 NG组、 CR组相比, ND‐CH组和D‐( CH+ EH)组的RA ActEF增加( P ＜0 .05) ;与对照组、 NG组、 CR组和ND‐EH组相比, ND‐CH组和D‐( CH+ EH)组的RA ActEV增加( P ＜0 .05) .结论 OSAS不同左室构型患者右房结构和功能受损不同, ND‐CH和D‐(CH+EH) OSAS患者的右房结构和功能受损较重,提示临床需关注OSAS扩张性左室肥厚患者的右房结构和功能.
