阻塞性睡眠呼吸暂停低通气综合征患者Framingham心血管危险评分影响因素的研究

The influencing factors of Framingham cardiovascular risk score in patients with obstructive sleep apnea-hypopnea syndrome

目的应用 Framingham 危险评分研究 OSAHS 的疾病特点与心血管损害发生危险性的关系,探讨具有预测价值的指标。方法对120例 OSAHS 患者进行 Framingham 危险评分,并依据该评分是否小于10分为低危组和非低危组,比较两组的临床指标(性别、年龄、BMI、NC、病程、ESS)、多导睡眠图(PSG)指标(AHI、ODI、LSaO_2、TS90)及血清学指标(hs-CRP),并进行相关分析及多元回归分析,以探讨各指标对 Framingham 危险评分的影响。结果除传统心血管疾病危险因素外,与低危组相比,非低危组患者颈围更大[(40.48±2.80)cm vs(39.15±4.31)cm,t=2.309,P<0.05)、打鼾病程更长[(12.77±7.89)年 vs(9.36±5.98)年,t=2.595,P<0.05)]、疾病程度更严重[AHI(47.61±25.63)vs(34.01±25.72),t=2.874,P<0.01;LSaO_2 73.85%±11.10%vs 77.91%±9.77%,t=-2.129,P<0.05;TS90 23.46%±24.46%vs 14.48%±18.85%,t=2.023,P<0.05;ODI49.62±23.75 vs 39.01±24.87,t=2.990,P<0.05]。相关分析发现 Fragmingham 危险评分与 PSG 指标中的 AHI(r=0.284,P=0.002)、ODI 呈正相关(r=0.224,P=0.014),与 LSaO_2呈负相关(r=-0.212,P=0.020),其中 AHI 对 FRS 的影响最大(t=2.910,P=0.004)。但两组患者血清 hs-CRP水平分布的差异无统计学意义(P=0.567)。结论 OSAHS 患者心血管损害与反复发生的夜间缺氧有关,AHI 为具有重要预测价值的 PSG 指标。

Objective To compare the predictable value of different index in evaluating the risk of cardiovascular injury in the patients with obstructive sleep apnea-hypopnea syndrome （OSAHS） by using Framingham Risk Score （FRS）. Methods 120 OSAHS patients were divided into 2 groups with different levels of cardiovascular injury according to the FRS： low risk group （with the FRS 〈 10） and non-low risk group （with the FRS≥10）. Data about medical history, gender, age, blood pressure, height, distribution, BMI, neck circemference （NC） Epworth sleepiness scale （ESS） SCORE were collected. Polysomnography （PSG） was used to measure the apnea-hypopnea index （AHI）, oxygen desaturation index （ODI）, lowest SaO2 during sleep （ LSaO2 ）, time spent below 90% oxygen saturation （TS90）. Peripheral blood samples were collected to examine the serum high-sensitivity C-reactive protein （hs-CRP）. Correlation analysis was conducted. Results Except the traditional risk factors for coronary heart disease, the subjects with higher FRS were found with bigger NC [ （40. 48 ± 2. 80） cm vs （ 39. 15 ± 4. 31 ） cm, P 〈 0. 05 ], longer course of disease [（12.77±7.89） y vs （9.36 ±5.98） y, P〈0.05], higher AHI （47.61 ±25.63 vs 34.01 ± 25.72, P 〈0.01）, lower LSaO2 （73.85% ± 11.10% vs 77. 91±9.77%, P 〈0.05）, longer TS90 （23.46%±24.46% vs 14.48% ±18.85% , P 〈0.05）, and higher ODI （49.62 ±23.75 vs 39.01 ±24. 87, P 〈 0.05 ）. Stepwise multivariate regression showed that FRS was positively correlated with AHI and ODI, and negatively correlated with LSaO2. All the PSG index, AHI had the most important impact on FRS （t = 2. 910, P = 0. 004）. There was no significant difference in hs-CRP level between different groups （P = 0. 649）. Conclusion The cardiovascular injury in OSAHS patients is correlated with repeated hypoxia during sleep-time. AHI is the most important PSG index to predict this kind of damage.