阻塞性睡眠呼吸暂停低通气综合征与肺血栓栓塞症影响因素的Logistic研究

Logistic research of obstructive sleep apnea-hypopnea syndrome and influence factors of pulmonary thromboembolism

目的:探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与肺血栓栓塞症(PTE)之间的关系,以及OSAHS对PTE患者抗凝治疗所需华法林剂量的影响。方法:选择2007年至2012年北京安贞医院呼吸科住院的PTE伴或者不伴OSAHS患者100例,根据睡眠监测或柏林问卷结果将患者分为PTE合并OSAHS组(试验组)34例,无OSAHS组(对照组)66例。分析两组的发病年龄、体质量指数(Body Mass Index,BMI)、吸烟史、糖尿病史、血脂异常、TC、TG、红细胞计数、HGB、血小板计数、C反应蛋白、未吸氧状态氧分压(PO2)、二氧化碳分压(PCO2)、出院时国际标准化比率(international normalized ratio,INR)及对应的华法林剂量。结果:OSAHS组与无OSAHS组在性别、BMI、糖尿病史、血脂异常发生率间,差异具有统计学意义(P<0.05);两组患者TG水平、未吸氧状态PCO2值之间差异具有统计学意义(P<0.05);出院时两组华法林剂量[(5.53±1.44)vs.(4.19±1.26)mg,P<0.05)],矫正体质量后OSAHS组所需华法林剂量仍偏高(P<0.05)。Logistic回归分析结果提示:男性、肥胖或者超质量、糖尿病为OSAFTS的影响因素(P<0.05)。结论:OSAHS与PTE的高危因素密切相关,这可能是OSAHS患者PTE发病率增高的原因之一。

Objective：To study the association between obstructive sleep apnea-hypopnea syndrome （OSAHS） and pulmonary thromboembolism（PTE）,and the effect of OSAHS on the dose of warfarin used in anticoagulant therapy in patient with PTE.Methods：The study selected the total of 100 PTE patients hospitalized in the Department of Respiratory Medicine of Capital Medical University affiliated Beijing Anzhen Hospital from 2007 to 2012.The patients were divided into two groups according to polysomnography or Berlin Questionnaire：OSAHS group （n =34） and non-OSAHS group （n =66）.The following indexes were analyzed in both groups：age,body mass index （BMI）,smoking history,diabetes mellitus,total cholesterol （TC）,plasma triglycerides （TG）,erythrocyte,hemoglobin and platelet,c-reactive protein and PO2 and PCO2 the blood gas analysis without administration of oxygen.,International Normalized Ratio （INR） and the dose of warfarin when left hospital.Results：OSAHS group and without OSAHS group has differents in sex,BMI,history of diabetes （P ＜ 0.05）.TC and PCO2 of the OSAHS group are different from non-OSAHS group （P ＜ 0.05）.The group which had a bigger dose of warfarin when left hospital was OSAHS group（OSAHS group vs non-OSAHS group：（5.53 ± 1.44） vs.（4.19 ± 1.26）mg,P ＜0.05）.While there are no different in other test index.Logistic study suggest that male,obesity or overweight,diabetes are the influence factors of OSAHS（P ＜ 0.05）.Conclusion：OSAHS is associated with PTE risk factors,which may be the reason why OSAHS patients has higher occurrence rate of the PTE.