阻塞性睡眠呼吸暂停对冠状动脉粥样硬化斑块的影响

Effect of obstructive sleep apnea syndrome on coronary atherosclerosis plaque

目的探讨阻塞性睡眠呼吸暂停（OSAS）对冠状动脉粥样硬化斑块的影响。方法126例老年冠心病（CAD）患者根据多导睡眠仪监测结果，分为OSAS合并CAD组（62例）、无OSAS组（64例）。所有患者常规清晨空腹卧位取静脉血测定测定胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、血常规白细胞计数、中性粒细胞分类及血清（hs—CRP）水平。根据冠状动脉造影术、64层螺旋CT检查结果记录OSAS合并CAD组、无OSAS组冠状动脉病变、Gensini评分及粥样硬化斑块情况。结果CAD合并OSAS组TC、TG、LDL-C分别为（5．76±0．85）mmol／L、（3．37±0．97）mmol／L、（3．65±0．58）mmol／L，HDL-C为（1．06±0．20）mmol／L，无OSAS组TC、TG、LDL-C分别为（4．26±0．78）mmol／L、（1．72±0．54）mmol／L、（2．91±0．58）mmol／L，HDL—C为（1．13±0．14）mmot／L，CAD合并OSAS组TC、TG、LDL-C均高于无OSAS组（t值分别为2．959、3．556、2．165，P〈0．05），HDL-C低于无OSAS组（t=2．545，P〈0．05）；OSAS合并CAD组患者血白细胞数、中性粒细胞百分比及hs—CRP水平较无OSAS组明显增高（P〈0．05）；OSAS合并CAD组冠状动脉多支病变发生率为51％，Gensini积分为（23．6±20．7）分，冠状动脉软斑块为（67．6±9．7）个，无OSAS组分别为30％，（18．9±19．4）分。（39．3±9．4）个，两组比较差异有统计学意义（t值分别为5．39，2．048，19．001，P〈0．05）。结论OSAS和冠状动脉粥样硬化性心脏病密切相关，促进冠状动脉粥样硬化斑块的形成。

Objective To investigate the effect of obstructive sleep apnea syndrome （OSAS） on coronary atheroselerosis plaque. Methods A total of 126 old patients with coronary artery disease （CAD） were selected and classified into two groups according to their results of polysomnography and coronary angiography： OSAS plus CAD group （n=62）; no OSAS group （n=64）. Peripheral venous blood samples were taken, and the levels of total cholesterol （TC）, triglyceride （TG）, high-density lipoprotein （HDL-C）, low density lipoprotein （LDL-C）, white blood cell counts, neutrophil percent and high sensitive C reactive protein （hs-CRP） were measured. The cases with coronary lesion, Gensini scores and atherosclerosis plaque were recorded according to coronary arteriography and 64- slice spiral coronary CT angiography. Results The levels of TC, TG and LDL-C were higher in OSAS plus CAD group than in no OSAS group 〈（5.76±0.85） mmol/L vs. （4.26±0.78） mmol/L, （3.37±1.97） mmol/Lvs. （1.72±0.54） mmol/L, （3.65±0.58） mmol/Lvs. （2.91±0.58） mmol/ L, t= 2. 959, 3. 556, 2. 165, all P〈0. 051. The levels of HDL were lower in OSAS plus CAD group than in no OSASgroup （（0. 86±0. 20） mmol/L vs. （1.13±0.14） mmol/L, t=2.545, P〈0.051. The white blood cell counts, neutrophil percent and serum hs- CRP levels were higher in OSAS plus CAD group than in no OSAS group （all P〈0.05）. In OSAS plus CAD group, the prevalence of muhivessel disease was 51%, Gensini scores were （23.6 ± 20.7） and coronary atherosclerosis plaques were （67.6±9.7） ,while the prevalence of multivessel disease was 30%, Gensini scores were （18.9± 19.4） and coronary atherosclerosis plaques were （39.3 ± 9.4） in no OSAS group. There were significant differences in the three parameters between the two groups （ z or t=5.39, 2. 048, 19. 001, all P〈0.05）. Conclusions OSAS is associated with coronary artery disease and can accelerate the formation of coronary atherosclerosis plaque.