肥胖青少年阻塞性睡眠呼吸暂停综合征患者上气道周围软组织MRI分析

MRI analysis on soft tissue around upper airway in obese adolescent patients with obstructive sleep apnea syndrome

目的:通过对青少年阻塞性睡眠呼吸暂停综合征(OSAS)患者上气道的核磁共振影像学(MRI)分析,探讨上气道软组织结构与青少年人群OSAS发病的关联性。方法:根据多导睡眠监测和体质量指数计算结果,将患者分为肥胖OSAS组(28例)、肥胖对照组(28例)和正常体质量对照组(28例)。应用MRI技术对3组受试者的上气道进行矢状位和轴位扫描;应用Amira医学影像分析系统对上气道MRI进行各个层面以及软组织的分析。结果:肥胖OSAS组和肥胖对照组患者舌体积明显大于正常体质量对照组(P<0.05);肥胖OSAS组患者扁桃体、腺样体体积明显高于2个对照组(P<0.05或P<0.001),2个对照组间比较差异无统计学意义(P>0.05);肥胖OSAS组患者咽侧壁体积高于肥胖对照组和正常体质量对照组(P<0.05或P<0.001),肥胖对照组高于正常体质量对照组(P<0.05)。肥胖OSAS组上气道软组织体积与睡眠呼吸暂停指数(AHI)相关分析,咽侧壁体积和腺样体体积与睡眠呼吸暂停指数(AHI)呈正相关(r=0.879,P<0.01;r=0.824,P<0.01)。结论:扁桃体、腺样体肥大仍然是肥胖青少年OSAS上气道阻塞的主要原因;肥胖加重上气道周围部分软组织体积(如舌体和咽侧壁体积)的增大,从而加重上气道阻塞;咽侧壁和腺样体体积在青少年OSAS病情严重性方面发挥重要作用。

Objective To investigate the correlation of soft tissue structure of upper airway with the pathogenesis of obstructive sleep apnea syndrome（OSAS） in adolescents age group by analyzing magnetic resonance imaging（MRI） of upper airway.Methods The subjects were divided into obese OSAS,obese controls and normal weight controls groups according to the results from polysomnography and body mass index measurements;Upper airway was scanned by MRI sagittally and axially;upper airway at all levels and soft tissue was analyzed by Amira Medical image analysis system.Results Tongue volumes in obese OSAS and obese controls were significantly greater than that in normal weight controls（P0.05）;tonsil and adenoid volumes in obese OSAS were significantly higher than those in two control groups（P0.05 or P0.001）,but no significant difference was found between two control groups.The volumes of lateral pharyngeal wall in obese OSAS were higher than those in obese controls and normal weight controls（P0.05 or P0.001）,and they were higher in obese controls compared with normal weight controls（P0.05）.In obese OSAS group,positive correlations were found between volumes of lateral pharyngeal wall and apnea/hypopnea index（AHI）（r = 0.879,P0.01）,as well as volumes of tonsils and AHI（r = 0.824,P0.01）.Conclusion Obesity can increase the soft tissue volumes around upper airway,thereby increase the upper airway obstruction;lateral pharyngeal wall and adenoid volumes play major roles in evaluating the severity of OSAS in adolescents.