【作者】 何烈纯；

【导师】 孔维佳；

【作者基本信息】 华中科技大学 ， 耳鼻咽喉头颈外科， 2012， 博士

【摘要】 第一部分阻塞性睡眠呼吸暂停低通气综合征疾病严重程度与代谢综合征目的：探讨不同程度阻塞性睡眠呼吸暂停低通气综合症(obstructive sleep apnea hypopnea syndrome, OSAHS)患者代谢综合征的发病率、影响因素及临床特点。方法：采用回顾性分析,97例经整夜多导睡眠监测确诊为OSAHS患者,依AHI指数分为轻中度(5-≤AHI<30)、重度(30<AHI<55)及极重度(AHI>55)3组,询问、记录高血压、冠心病、糖尿病或糖代谢异常、高血脂或脂代谢异常病史及用药史,测量记录收缩压、舒张压、身高、体重、颈围、腰围等一般身体情况。整夜睡眠监测次日晨起时标准静脉穿刺抽取前臂肘静脉空腹血,全自动生化分析仪检测空腹血糖、血总胆固醇、甘油三脂、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇等生化指标。依“2007年中国成人血脂异常防治指南”对代谢综合征进行诊断。分析比较不同程度OSAHS患者代谢综合征的发病率、在不同组别的分布特点、临床特征等。计量数据用均数±标准差(mean±sd)表示,使用spss17.0统计软件进行数据统计与分析,采用非参数独立样本t检验比较组内、组间差异性,P<0.05,认为差异具有统计学意义,P<0.01,认为差异具有高度统计学意义。Pearson相关性检验两组数据之间的相关性。采用多因素logistic回归分析以除外混杂因素对结果的影响。结果：本研究OSAHS组中代谢综合征的发病率为48.5%,各组别的发病率分别为：轻中度组为33.3%,重度组为43.3%,极重度组57.1%。显示随AHI指数的增加,代谢综合征的发病率也逐步增高,二者之间显著相关(t=-2.39,P=0.019)。与未合并代谢综合征的OSAHS患者相比,合并代谢综合征的OSAHS患者的腹围(t=-3.32,P=0.001)、体块指数(t=-3.23,P=0.002)、最低血氧饱和度(t=2.47,P=0.015)、3%氧减指数(t=-2.18,P=0.032)等均存在有统计学意义或显著统计学意义的差异。在代谢相关指标如空腹血糖、甘油三酯、高密度脂蛋白等二者之间也存在有统计学意义的差异。结论：代谢综合征是OSAHS患者的并发症之一,并随OSAHS程度加重其患病率逐步增加。腹型肥胖、夜间反复低氧血症可能是OSAHS患者并发代谢综合征的危险因素之一。第二部分OSAHS患者疾病严重程度临床评估的初步探讨目的: OSAHS是多器官多系统的综合征,单一AHI指数不能全面反映其疾病严重程度,单纯依靠AHI指数判断疾病严重程度,可能会导致临床治疗的过度或不足。本研究目的是建立以并发或伴发疾病严重程度配合OSAHS基础生理指标的评估模型,以期更好的指导临床。方法：按制定的入选与排除标准,经整夜多导睡眠监测诊断为OSAHS患者,共97例资料完整病例进入本研究。对所有病例按制定的临床评估模型进行评估,比较其结果与AHI指数及临床症状的差异性。计量数据用均数±标准差(mean±sd)表示,使用spss17.0统计软件进行数据统计与分析,采用非参数独立样本t检验比较组间差异性,P<0.05,认为差异具有统计学意义,P<0.01,认为差异具有高度统计学意义。结果：按AHI指数分组,7例轻度OSAHS患者经临床评分后,有2例被评为临床中度,3例被评为重度。加分项目主要有：2例为血压升高,2例为脂代谢异常,4例为白天嗜睡明显。12例中度OSAHS患者经临床评分后,2例被评为轻度,9例被评为重度,加分项目主要有：7例为脂代谢异常,2例为血压升高,1例为糖代谢紊乱。78例重度OSAHS患者中经临床评分后,6例被评为轻度,3例被评为中度,其余被评为重度,但得分均有上升。6例被评为轻度患者均无明显并发或伴发疾病,3例被评为中度者伴发疾病为舒张压升高。在评为重度患者中普遍加分超过3以上,主要以脂代谢异常及白天嗜睡明显。少部分为血压或空腹血糖异常。经统计学处理,AHI分组评估与临床模型评估结果相比较,差异明显。结论：以OSAHS伴发或并发疾病配合基础生理指标评分来评价0SAHS疾病严重程度明显好于单一使用AHI指数,更有利于指导临床干预。更多还原

【Abstract】 A prelimary study on the severity of obstructive sleep apnea hypopnea syndrome and the metabolic syndromeObjective:To explore the prevalence of metabolic syndrome among the obstructive sleep apnea hypopnea syndrome (OSAHS) patients of varying degrees and evaluate the potential association between the parameters of metabolic syndrome and OSAHS.Methods:Prospectively,97consecutive patients, diagnosed as OSAHS based on the over night polysomnography, divided into three groups according to the apnea hypopnea index(AHI):mild and moderate (5≤AHI<30)、severe (30≤AHI <55) and profound (AHI≥55). History of Hypertension, cardiovascular or cerebrovascular disease, coronary heart disease, diabetes mellitus, dyslipidemia and systemic medication use, anthropometric data such as age, sex, height, neck, waist circumferences, systolic blood pressure, diastolic blood pressure etc were recorded. Fasting blood samples were obtained the morning after polysomnography, between08:00and09:00hours. Fasting blood glucose, total cholesterol, triglycerides, high density lipoprotein and low dengsity lipoprotein cholesterol levels were measured by the full automatic biochemical analysis system (Olympus AU5400). Diagnosis of metabolic syndrome was based on the2007guideline for the prevention and treatment for the dyslipidemia of Chinese adult. The prevalence of the metabolic syndrome and the components of its distribution in the different OSAHS groups were explored. Descriptive statistics were expressed as mean±standard deviation(sd). One sample Kolmogorov-Smirnov test was used to test the normal distribution. Independent-Samples T test was used for exploring the difference between two categorical variables. Pearson correlation was used to test the relationgship between the two categorical carables. The association between the presence of metabolic syndrome and the presence of OSAHS, adjusted for BMI, was determined using logistic regression. All analyses were performed using SPSS v17.0(Statistical Package for Social Sciences, Chicago, IL, USA). Results:The prevalence of metabolic syndrome was48.5%among the patients with OSAHS. The morbidity of metabolic syndrome among the defferent groups were:mild&moderate group (33.3%), severe group (43.3%), profound group (57.1%), increased by degrees with the ascending of AHI. There was a significant statistic difference between the OSAHS patients with or without metabolic syndrome(t=-2.39, P=0.019). There were statistic or significant statistic differences between the two groups for the anthropometric and sleep panels including abdominal circumference (t=-3.32, P=0.001)、body mass index (t=-3.23, P=0.002)、lowest oxygen saturation (t=2.47, P=0.015)、3%oxygen desaturation index (t=-2.18, P=0.032). OSAHS patients with metabolic syndrome had significant higher blood level of fasting glucose, triglycerides and lower blood level of high density lipoprotein cholesterol than those without metabolic syndrome.Conclusion:The results of this study suggested that metabolic syndrome is a main comorbidity of OSAHS and the prevalence of metabolic syndrome increased with the severity of OSAHS. Abdominal obesity and the recurrent nocturnal intermittent hypoxemia might be the risk factor for OSAHS patients developing metabolic syndrome. Part Two:A primary clinic study on the evaluation of the severity of obstructive sleep apnea hypopnea syndromeObjective:OSAHS is a disease with many comorbidities, such as diabites, hypertension, obesity, etc. Apnea hypopnea index is widely used to evaluate the severity of OSAHS. The limit of AHI is it can only reflect the hypoxemia and it might lead to a over or insufficient treatment of OSAHS with comorbidities. The present study is a premary research on how to establish a model of clinic evaluation of OSAHS with comorbidities.Methods:Prospectively, according to the criteria,97consecutive patients, diagnosed as OSAHS based on the over night polysomnography were included in the research. They were divided into three groups according to the apnea hypopnea index(AHI):mild (5≤AHI<15)、and moderate (15≤AHI<30) and severe profound(AHI≥30). Data of general demography and comorbidities were recorded. These data were evaluated with a clinic evaluating model established by us. The results were compared with the apnea hypopnea index. Chi-Square test was used for exploring the difference between two categorical variables. All data were handled by SPSS17.0(Statistical Package for Social Sciences, Chicago, IL, USA).Results:After estimated by the clinic evaluating model, among the7cases of mild group,2cases were regarded as moderate,3cases as severe. The adding score items were hypertension, dyslipidemia and daytime sleepiness. Among the12cases of moderate group,2cases were regarded as mild, while9cases as severe. The influnce factor were hypertension, dyslipidemia and abnormal glucose metabolism. Among the78cases of severe group,6cases were classified as mild,3as moderate due to the absence of comorbidity. The rest were repeatedly classified as severe, but more profound. There were a significant statistic difference between the AHI and the clinic evaluating model (P<0.05)Conclusion:It was better to assess the severity of OSAHS along with the comorbidity than simply with AHI. It can give a more effective guildline to the clinic treatment of OSAHS.更多还原