阻塞性睡眠呼吸暂停低通气综合征患者血尿酸变化的临床意义

The relationship between obstructive sleep apnea-hypopnea syndrome and blood uric acid levels

目的:了解不同程度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血尿酸水平的变化,并分析二者之间的相关性。方法:选择我院2007年3月至2009年7月就诊的OSAHS患者80例,根据睡眠监测得出的睡眠呼吸暂停低通气指数(AHI)分为轻度OSAHS组(5次/h≤AHI≤20次/h,27例)、中度OSAHS组(20次/h<AHI≤40次/h,19例)、重度OSAHS组(AHI>40次/h,34例)和对照组(AHI<5次/h,20例);观察各组年龄、性别、体质量指数(BMI)、血清胆固醇、甘油三脂、血糖、尿酸及睡眠各项指标变化,比较3组间各观察指标的差异;对OSAHS组血清尿酸水平与AHI、最低脉搏容积血氧饱和度(LSpO2)和氧减<90%的时间T90进行相关性分析。结果:组间年龄及性别相比差异均无统计学意义(P均>0.05)。轻、中度OSAHS组血尿酸水平分别为(365.30±92.37)μmol/L,(374.63±78.17)μmol/L均高于对照组(336.82±74.08)μmol/L,但差异无统计学意义;重度OSAHS组血清尿酸水平(440.26±92.14)μmol/L与对照组比较差异有统计学意义(P<0.01);OSAHS组血清尿酸水平与AHI、T90呈显著正相关(r值分别为0.441、0.309,P均<0.001)与LSpO2呈负相关(r值为-0.370,P<0.001)。结论:OSAHS患者中血清尿酸水平随着AHI的增加和缺氧程度的加重而增高,并与AHI、T90及LSpO2有较强的相关性。提示OSAHS患者反复发作低氧血症可能是心血管病高发的另一个原因。

Objective：To investigate the association between obstructive sleep apnea-hypopnea syndrome（OSAHS）） and serum uric acid concentrations.Method：From March of 2007 to July of 2009,80 subjects admitted into Department of Respiratory of the Beijing Anzhen Hospital of The Capital Medical University were recruited.They were divided into three groups based on their nocturnal apnea hypopnea index（AHI） detect by examination of polysomnography： mild OSAHS group （5/h ≤ AHI ≤ 20/h, 27 cases）, moderate group （20/h 〈 AHI ≤ 40/h, 19 cases）, severe group（AHI 〉 40/h, 34 cases） and 20 snorers without OSAHS were selected as control group （AHI 〈 5/h）. The difference of age, sex, BMI, plasma cholesteroI, triglyceride,glucose, uric acid, AHI, LSpO2 and 3-90 among four groups were analyzed. Analysis of variance, One-Way ANOV A, Nonparametric test and Partial correlation analysis were used for statistics. Result：Compared with the control group, the AHI was significandy higher in OSAHS groups （mild 10.20 ± 3.71, moderate 29.48 ± 5.60, severe 61.32 ± 116.22 versus 2.42 ± 1.40）. The lowest SpO2 was significantly lower in OSAHS groups [ 85 % （81% -88 % ）, 81% （77 %-84 % ）, 73 % （64 % -77 % ） 1 than that in the control group [90% （87%-92%）]. The total recorded time spent below 90% oxygen saturation （T90） [10.2 （3.3-25）, 41（18.3-9g.6）, 149（45.6-226.7）1 was significantly higher in OSAHS groups than that in the control group [0.0（0.0-0.19）t. Compared with the control group, the age, sex did not show significant difference（ P 〉 0.05）. The serum uric levels were significantly higher in patients with severe OSAHS group than that in the control group （ P 〈 0.01 ）. Serum uric acid are positively correlation with AHI and T90 （ r = 0.441, P 〈 0.001 ; r = 0. 309,P〈 0.01 ）, but negatively with the lowest SpO2 （ r = - 0.37, P 〈 0.001 ）. Conclusion： Serum uric acid concentrations rose as the number of respiratory events and anoxemia of degree in patients with OSAHS. The occurrence of coronary heart disease in OSAHS patients is probably related to recurrent nocturnal hypoximea during sleep.