阻塞性睡眠呼吸暂停综合征患者上气道MRI观察

The upper airway MRI of obstructive sleep apnea patients

目的 通过比较清醒状态下阻塞性睡眠呼吸暂停综合征 (obstructivesleepapneasyndrome,OSAS)患者与健康人上气道及其周围软组织的差异 ,探讨OSAS的发生机制。方法 应用磁共振成像 (magneticresonanceimagiug ,MRI)对 1 8例经多导睡眠监测 (PSG)确诊的OSAS患者的上气道扫描 ,对上气道的软腭后区 (retropalatalregion ,RP)、舌后区 (retroglossalregion ,RG)和会厌区 (epiglottalregion ,EPG)截面积、各区咽壁厚度、RP区咽侧脂肪垫 (lateralparapharyngealfatpad ,LPFP)的截面积等进行测量。选择 1 9例无打鼾的同年龄组健康人做对照组。结果 ①患者组RP、RG区气道截面积小于对照组 (P <0 0 5 ) ;患者组EPG区气道截面积与对照组无统计学差异 (P =0 2 0 4) ;②患者组RP、RG、EPG区气道前后径与左右径 (AP/L)比值均大于对照组 (P <0 0 5 ) ;③患者组RP区LPFP截面积大于对照组 ,(P <0 0 1 ) ;④患者组RP、RG、EPG区咽后壁厚度大于对照组 (P <0 0 5 ) ,患者组RP区咽侧壁厚度与对照组无统计学差异 ,而患者组RG和EPG区咽侧壁厚度均大于对照组 (P <0 0 5 ) ;⑤正中矢状位测量患者软腭截面积、厚度和长度均大于对照组 (P <0 0 1 )。结论 上气道截面积及其AP/L比值、咽侧壁厚度、咽后壁厚度 。

Objective To investigate the mechanisms of obstructive sleep apnea syndrome(OSAS) through observing the upper airway caliber and its corresponding pharyngeal wall of OSAS patients by MRI Methods The upper airway(UA)of 18 OSAS patients were examined by MRI The cross sectional area of the UA and lateral parapharyngeal fat pad (LPFP) were calculated The thickness of lateral and posterior pharyngeal wall (LW & PW) and other related indices were also measured Nineteen nonsnoring age matched normal subjects were selected as the control group Results ①The retropalatal (RP) and retroglossal (RG) region UA cross sectional areas of OSAS patients were smaller than that of the control ( P <0 05) The epiglottal (EPG ) region UA cross sectional area was not significantly different between the 2 groups ( P =0 204) ②The anterior posterior / Lateral ratio(A P/L) of UA in RP, RG, EPG regions was bigger in patients group than that of the control ( P <0 05) ③The cross sectional area of LPFP in patients group was larger than that of the control group ( P =1 76E 7) ④The thickness of the PW in the RP、RG and EPG region was thicker in patients group than that of the control ( P <0 05). Although the thickness of the LW in the RP region was not statistically different between the 2 groups ( P =0 94),this index in RG and EPG region was larger in patients group than that of the control ( P =<0 05) ⑤ Sagittal MRI image showed that the length, thickness and cross sectional area of the palate in patient group was larger than that of the control ( P <0 01) Conclusions The study suggests that the pathogenesis of OSAS is related to the following factors: UA caliber and its AP/L ratio, the thickness of LW and PW, the size of LPFP in RP region, and the size and length of the palate