急性冠脉综合征患者夜间低氧血症对颈动脉硬化斑块的影响

Effects of nocturnal hypoxemia on carotid artery atherosclerosis and plagues in patients with acute coronary syndrome

目的研究急性冠脉综合征(ACS)患者夜间低氧血症对颈动脉粥样硬化斑块的影响。方法将110例ACS患者根据冠脉造影检查和睡眠呼吸监测结果分为三组:ACS组(Ⅰ组,n=37)、ACS合并阻塞型睡眠呼吸暂停低通气综合征-轻度以下夜间低氧血症组(Ⅱ组,n=36)、ACS合并阻塞型睡眠呼吸暂停低通气综合征-中度以上夜间低氧血症亚组(Ⅲ组,n=37)。所有患者均行颈动脉超声检查,对各组间颈动脉内膜中层厚度、斑块数量进行分析,并以Gensini积分比较不同组间冠脉病变严重程度。结果三组在传统冠心病危险因素差异无统计学意义(P>0.05),与Ⅰ组比较,Ⅱ组和Ⅲ组患者颈动脉内膜明显增厚,颈动脉斑块数明显增多(P<0.01);Ⅲ组比Ⅱ组颈动脉内膜明显增厚,总斑块数、软斑块数显著增多(P<0.01),混合斑块数、硬斑块数也明显增多(P<0.05);Ⅱ组和Ⅲ组中颈动脉IMT及斑块数量与夜间最低血氧饱和度成负相关;Ⅱ组与Ⅰ组Gensini积分无统计学差异(P>0.05)。Ⅲ组Gensini积分明显高于Ⅰ组和Ⅱ组(P<0.01)。结论夜间低氧血症对ACS患者颈动脉粥样硬化及斑块的形成可能具有一定作用。

Objective To investigate effects of nocturnal hypoxemia on carotid artery atherosclerosis and plagues in patients with acute coronary syndrome （ ACS）. Methods A total of 110 patients with ACS were classified into three groups according to results of coronary angiography （CAG） and polysomnography （PSG） ： ACS group （group Ⅰ , n =37） , ACS complicated with obstructive sleep apnea-hypopnea syndrome （OSAHS）-mild nocturnal hypoxemia group （group Ⅱ , n =36） , and ACS complicated with OSAHS-moderate and severe nocturnal hypoxemia group （group Ⅲ , n =37）. All patients were examined by carotid ultrasound to analyze carotid artery intimamedia thickness （IMT） and the number of plagues. And they were also compared in coronary artery pathological changes＇ severity degree according to Gensini score. Results Traditional coronary risk factors showed no significant difference among three groups （P 〉 0.05）. In group Ⅱ and Ⅲ, the carotid artery IMT was thicker and the amount of plagues were larger than those in group Ⅰ （P 〈 0.01）. Compared with group Ⅱ, the carotid artery IMT was thicker and the amount of total plagues and soft plagues were larger in group Ⅲ （P 〈 0.01）. The amount of mix plagues and hard plagues were also larger in group Ⅲ （P 〈0.05）. In group Ⅱ and Ⅲ , carotid artery IMT and the amount of carotid artery plagues were nagetively correlated with SaO2 during sleep at night. There was no difference in Gensini score between group Ⅰ and Ⅱ . The Gensini score of group Ⅲ was much bigger than those of group Ⅱ and Ⅰ （P 〈 0.01）. Conclusion Nocturnal hypoxemia probably made some impact on carotid atherosclerosis and the formation of carotid artery plagues in patients with ACS.