血栓弹力图评价老年冠心病合并睡眠呼吸暂停综合征患者高凝状态的临床价值

Clinical Value of Thromboelastograph in Evaluating Hypercoagulability Status in the Patients with Obstructive Sleep Apnea Hypopnea Syndrome and Coronary Artery Disease

目的评价血栓弹力图(TEG)在监测老年冠心病合并睡眠呼吸暂停综合征(OSAHS)患者高凝状态中的价值。方法从医院门诊和病房收集120例冠心病患者,行全夜多导无线睡眠描记器(PSG)监测后分为两组,其中无OSAHS冠心病组60例,有OSAHS冠心病组60例。对所有病例均行常规凝血功能、血常规及TEG检测。结果 (1)冠心病合并OSAHS的患者组中,体重指数(BMI)、腰围和颈围均较无OSAHS冠心病组明显增高(P<0.01),且前者平均收缩压和舒张压较后者明显增高(P<0.05)。(2)冠心病合并OSAHS组PSG显示:呼吸紊乱指数(AHI)、觉醒指数、氧减指数、SaO2<90%的时间以及I期睡眠和慢波睡眠所占的比例均明显高于无OSAHS冠心病患者组,差异有显著性(P<0.01)。而前者最低SaO2(%)(89±1.1)明显低于后者(78±1.2),差异有显著性(P<0.01)。(3)TEG显示有OS-AHS冠心病患者组的R时间、K时间均较无OSAHS冠心病组低,Angle(α)及CI均较无OSAHS冠心病组高,差异有统计学意义(P<0.05),而两组MA间差异无统计学意义(P>0.05)。(4)两组患者在血色素(Hb)、血小板数量(PLT)以及常规凝血功能各指标间差异均无统计学意义(P>0.05)。结论冠心病合并OSAHS患者存在血液高凝状态,与其他常规凝血功能检查比较,TEG是反映高凝状态的一个更为敏感的指标。该组患者的高凝状态是由于纤维蛋白和血小板活性明显增高所致,这对该类患者的抗凝治疗有一定的指导意义。

Objective To assess clinical value of thromboelastograph （TEG） in monitoring hyperco- agulability status in the patients with obstructive sleep apnea hypopnea syndrome （OSAHS） and coronary artery disease（CAD）. Methods Data of 120 patients in- or out-patients with proven CAD were analyzed. According to PSG ,patients were divided into CAD with OSAHS group（ n =60） and CAD without OSAHS group （ n = 60）. TEG, DIC and blood routine tests had been taken out in all patients. Results （ 1 ） In the CAD with OSAHS group,body mass index （ BMI）, the waistline and neck circumference were more than those in the CAD w!thout OSAHS group（P 〈0.01 ）. Moreover,average systolic and diastolic blood pressure in the CAD with OSAHS group were higher than those in the latter（ P 〈0.05 ）. （2）PSG results showed： apnea hypopnea index, arousal index,oxygen desaturation index,the time of oxygen saturation less than 90% ,and the percentage of stage I and slow wave were higer than those in CAD without OSAHS significantly（P 〈 0.01 ）. However the lowest oxygen saturation（ SpO2 ） was lower in the former than in the latter（ 89±1.1 vs 78±1.2） （P 〈 0.01 ）. （3）Significant differences existed between TEG parameters of the two groups, with R and K values lower in the CAD with OSAHS group than those in CAD without OSAHS, with Angle （a）and CI values higher in the CAD with OSAHS group than without OSAHS group （P 〈 0.05 ）. However, MA between two groups had no significant difference（P 〉 0.05 ）. （4）No significant differences was noticed in results from routine blood and conventional coagulation, parameters between two groups （ P 〉 0.05 ）. Conclusions The CAD patients with OSAHS exist hypereoagulability status. TEG might be a much more sensitive method to reveal the exist- enee of hypercoagulation status in them compared to conventional coagulation examination. Hypereoagulability is more related to hyperfibrinogenemia and hyperactivity of platelet, which is helpful to anticoagulant therapy.