应用超声射频血管内中膜分析和血管硬度定量技术评价睡眠呼吸暂停患者颈动脉结构和功能

Evaluation of structure and stiffness of the common carotid artery in patients with obstructive sleep apnea syndrome by ^RF QIMT and ^RF QAS technology

目的应用超声射频信号血管内中膜分析（^RF QIMT）技术和血管硬度定量分析（^RF QAS）技术评价阻塞性睡眠呼吸暂停综合征（OSAS）患者颈动脉结构和功能，并探讨其心血管危险因素。方法113例因打鼾疑为OSAS的患者根据呼吸暂停低通气指数（AHI）〈5、5～20、20-40、〉40次／h分为对照组及OSAS轻度、中度、重度4组，应用^RF QIMT和^RF QAS技术检测颈总动脉内中膜厚度（IMT）、内径（D）、内径变化幅度（Dis）、扩张系数（DC）、顺应系数（CC）、脉搏波传导速度（PWV）及僵硬度α、β，观察4组间参数的差异，并应用多重线性回归分析其危险因素。结果①一般临床资料：4组间比较，血压逐渐升高（P〈0．05）。平均血氧饱和度（SO2）、最低血氧饱和度（SO2 min）在OSAS轻、中、重组逐渐减小，氧饱和度低于90％的时间占睡眠时间百分比（T90）、氧解离指数（ODI）逐渐增大（P〈0．05）。②颈动脉QIMT及斑块：4组间差异有统计学意义（P〉0．05）。③颈动脉QAS参数：与对照组比较，OSAS轻度组Dis增大，中度组PWV、α、β增大（P〈0．05）。与OSAS轻度组比较，中度组PWV、α、β增大（P〈0．05）。与OSAS中度组比较，重度组α、β增大（P〈0．05）。④多重线性回归结果提示：年龄是影响IMT、Dis、DC、CC、PWV、α、β的主要因素（P〈0．05）；夜间收缩压下降率是D、DC、CC、PWV的影响因素（P〈0．05），白天收缩压、夜间收缩压、白天脉压是影响D的主要因素（P〈0．05），SO2是影响PWV的显著因素（P〈0．05），脉压（PP）是影响PWV、α、β的显著因素（P〈0．05）；吸烟是斑块形成的预测因素（P〈0．05）。结论①随着OSAS病情加重，颈动脉弹性显著减低，但结构指标无差异，提示OSAS患者颈动脉弹性异常早于形态学的改变。②PP、夜间收缩压下降率及SO2是影响OSAS颈动脉弹性功能的显著因素，提示昼夜血压变化及低氧是影响颈动脉弹性的重要因素。

Objective To evaluate the structure and stiffness of the common carotid artery （CCA） in patients with obstructive sleep apnea syndrome （OSAS） by RFQIMT and RFQAS technology and analyze the relationships between the parameters of CCA and cardiovascular risk factors. Methods 113 participants with habitual snoring suspected OSAS were divided into control group, mild, moderate and severe OSAS groups according to apnea hypopnea index（AHI）〈5,5 - 20,20 - 40, 〉40 event/hour respectively. Carotid parameters included intima-media thickness （IMT）, diameter （D）, distension （Dis）, distensibility coefficient （DC）,compliance coefficient （CC）,pulse wave velocity （PWV）, stiffness index a and β were collected by ^RF QIMT and ^RF QAS. Multivariate linear regression analysis was applied to analyze the relationships between CCA parameters and cardiovascular risk factors. Results ①The clinical characteristics：blood pressure hadsignificant difference among the four groups （ P 〈0. 05）. SO2, SO2 min decreased and T90, ODI increased significantly in mild, moderate and severe group （ P 〈0.05）. ②The structure parameters of CCA.. IMT, D and plaques had no significant difference among the four groups （ P〈0.05）. ③The elasticity parameters of CCA..Compared with control group, Dis increased significantly in mild group （P 〈0.05）. PWV, α, β increased significantly in moderate group （P 〈0.05）. Compared with mild group, PWV, α, β increased significantly in moderate group （ P〈0.05）. Compared with moderate group, α,βincreased significantly in severe group （ P 〈0.05）.④By multivariate linear regression analysis,age was an independent predictor of IMT,Dis,D,CC,PWV, α, β（ P 〈0.05）. A blunted nbcturnal fall was an independent predictor of D, DC, CC,PWV （ P 〈0.05）, SBP,DBP and PP of daytime had an important effect on D （ P 〈0.05）. SOs was independently correlated with PWV （ P 〈0.05）. PP was an independent predictor of PWV, α, β （ P〈0.05）. Smoking was an independent predictor of plaque （ P 〈0.05）. Conclusions ①Stiffness is damaged earlier than morphology of CCA in patient with OSAS. ②PP, a blunted nocturnal fall and SO2 are correlated with stiffness of CCA significantly. It indicates that abnormal circadian blood pressure rhythm and hypoxia are associated significantly with stiffness of CCA in patient with OSAS.