阻塞性睡眠呼吸暂停综合征患者左心室重构及其影响因素的临床研究

Clinical study on left ventricular remodeling patterns and its relationships with cardiovascular risk factors in patients with obstructive sleep apnea syndrome

目的探讨阻塞性睡眠呼吸暂停综合征（OSAS）患者左室重构（LVR）类型及其心血管危险因素。方法对经多导睡眠仪监测睡眠呼吸暂停低通气指数（AHI）≥5次／h确诊为OSAS的患者148例，定点监测血压，次日晨行超声心动图检查。根据相对室壁厚度（RWT）≥0．42和左室质量指数（LVMI）≥46．7g／m2.7（女）或49．2g／m2.7（男），将患者按左室构型分为正常构型组（NG），向心性重构组（CR），离心性肥厚组（EH）和向心性肥厚组（CH），应用多变量logistic回归分析心血管危险因素与构型的相关性。结果①148例OSAS患者中115例（77．7％）左室构型异常，NG组33例（22．3％），CR组35例（23．6％），EH组37例（25％），CH组43例（29．1％）。②一般临床资料：与NG组比较，EH组BMI及腰围较高（P〈0．01），CH组年龄、BMI、腰围、高血压、白天及夜间平均收缩压（dSBP及nSBP）均较高（P〈0．05或P〈0．01）；与CR组比较，EH组年龄、BMI及腰围均较高（P〈0．05或P〈0．01），CH组男性、年龄、BMI、腰围、高血压、nSBP及TG均较高（P〈0．05或P〈0．01）；与EH组比较，CH组高血压发病率较高（P〈0．05）。③睡眠呼吸监测指标：与NG组比较，CR组AHI及氧减饱和指数（ODI）较高（P〈0．05或P〈0．01），CH组AHI、0DI及血氧饱和度低于90％的睡眠时间占总睡眠时间的百分比（T90）均较高，而平均动脉血氧饱和度（SaO2）及最低SaO2较低（P〈0．05或P〈0．01）；与CR组比较，EH组AHI较低（P〈0．05），CH组平均SaO2较低，T90较高（P〈0．05或P〈0．01）；与EH组比较，CH组最低SaO2较低（P〈0．05）。④血压：与NG组比较，CH组4：00SBP及6：00SBP较高（P〈0．05），与CR组比较，CH组22：00SBP较高（P〈0．05）。⑤采用多变量Logistic回归分析，校正混杂因素的作用后，AHI与CR相关（OR1．035，P=0．024），年龄、BMI及4：00SBP与EH相关（OR1．094，P=0．016，OR1．397，P=0．011，OR1．124，P=0．026），年龄与CH相关（OR1．084，P=0．028）。结论OSAS可导致LVR，四种构型所占比率相近。AHI、年龄分别为CR、CH的重要决定因素，年龄，BMI、4：00SBP是EH的重要决定因素。

Objective To investigate the left ventricular remodeling （LVR） patterns and its relationships with cardiovascular risk factors in patients with obstructive sleep apnea syndrome （OSAS）. Methods 148 patients with habitual snoring were diagnosed OSAS by polysomnography with AHI≥5 /h and blood pressure was monitored at same time. The clinical characteristics were collected and echocardiography was done next morning. LVR patterns was categorized as normal geometry （NG）, concentric remodeling （CR）,eccentric hypertrophy （EH） and concentric hypertrophy （CH） on the basis of RWT 〉0.42 and LVMI 〉46.7 g/m2.7 （female） or 49.2 g/m2.7 （male）. Muhinomial logistic regression was used to analysis the correlation of cardiovascular risk factors and LVR patterns. Results （1） Of 148 OSAS patients,there were 115 （77.7%） with abnormal LVR,NG 33 （22.3%）,CR 35 （23.6%）,EH 37 （25%） and CH 43 （29.1%）. （2）General clinical characteristics： Compared with NG group, BMI and waistline were increased in EH group （ P〈0.05 or P〈0.01）; Age,BMI, waistline, hypertension, dSBP and nSBP were increased in CH group （ P〈0.05 or P〈0.01）. Compared with CR group, male, age, BMI and waistline were increased in EH group （ P〈0.05 or P〈0.01）. Male,age,BMI,waistline,hypertension,nSBP and TG were increased in CH group （P〈0.05 or P〈0.01 ）;Compared with EH group, the prevalence of hypertension was increased in CH group （P〈0.05）; Compared with EH group, the prevalence of hypertension was increased in CH group （ P〈0.05）. （3）Polysomnography parameters：Compared with NG group,AHI and ODI were increased in CR group （P〈0.05 or P〈0.01）. AHI, ODI and T90 were increased,while Mean SaO2 and Lowest SaO2 were decreased in CH group （ P〈0.05 or P〈0.01） ; Compared with CR group,AHI was decreased in EH group （ P〈0.05）. Mean SaO2 was decreased,but T90 was increased in CH group （ P 〈0.05 or P〈0.01） ;Compared with EH group, Lowest SaO2 was decreased in CH group （ P 〈 0.05）. （4） Blood pressure： Compared with NG group, 4 ： 00 SBP and 6 ： 00 SBP were increased in CH group （ P〈0.05） ;Compared with CR group,22：00 SBP was increased in CH group （ P〈0.05）. （5） In multinomial logistic regression analysis, after adjusting the confounding factors, CR was associated with AHI [odds ratio （OR） 1. 035, P = 0. 024. EH was associated with Age （OR 1. 094, P = 0. 016） ,BMI （OR 1. 397, P = 0. 011） and 4：00 SBP （OR 1. 124, P = 0. 026）. CH was associated with Age （OR 1. 084, P = 0. 028）. Conclusions OSAS could cause result in LVR and the prevalence of four patterns were similar. Age and AHI were significant determinants of CH and CR respectively. Age, BMI and 4：00 SBP were significant determinants of EH.