冠心病、脉搏波传导速度及睡眠呼吸暂停综合征的关系

The relation among coronary artery disease, pulse wave velocity and obstructive sleep apnea syndrome

目的 探讨冠心病、脉搏波传导速度（PWV）及阻塞性睡眠呼吸暂停综合征（OSAS）三者间的关系以及可能的机制.方法 对2012年1～3月期间以冠心病或胸痛原因待查收入我中心的135例患者,进行冠状动脉造影、睡眠呼吸监测及PWV测定,抽血化验血脂、血糖、C-反应蛋白等,对其结果进行分析.结果 ①中重度OSAS组的冠心病发病率、Gensini评分明显高于轻度OSAS组[冠心病的发病率66.6％比45.8％,P＜0.05;Gensini评分（28.98±23.87）比（13.53±16.91）,P＜0.05];在单支病变、双支病变及多支病变三组中,中重度OSAS发病率差异有统计学意义,中重度OSAS发病率与病变支数呈正相关（R=0.376,P＜0.01）.②中重度OSAS组的PWV明显高于轻度OSAS组[PWV（m/s）：（1615.52±190.19）比（1349.97±222.58）,P＜0.01],PWV与睡眠呼吸暂停低通气指数（AHI）呈正相关（R=0.40,P＜0.01）.③冠心病组与非冠心病组PWV差异有统计学意义[（1621.24±190.31）比（1393.05±131.50）,P=-0.00],PWV在单支病变、双病变及多支病变三组中差异有统计学意义[（1476.20±163.52）比（1545.63±174.30）,（1545.63±174.30）比（1680.10±215.72）,（1476.20±163.52）比（1680.10±215.72）],与病变支数呈正相关（R=0.368,P＜0.01）,与Gensini评分呈正相关（R=0.60,P＜0.01）.结论 OSAS是冠心病的危险因素,OSAS的严重程度与冠脉病变支数及PWV呈正相关.PWV是体现动脉硬化的指标,我们推测OSAS所致动脉硬化可能是引起冠心病的一种机制.

Objective To investigate the correlation among coronary artery disease （CAD）,pulse wave velocity（PWV） and the sleep apnea syndrome（SAS）,and possible mechanism.Methods 135 patients who underwent coronary angiography （CAG） were enrolled between January 2012 and March 2012,PWV and home polysemnography monitoring were performed,and blood glucose,C-reactive protein were investigated.Results （1）The incidence of CAD and Gensini score in group of moderate or severe OSAS were higher than that in group of mild OSAS [incidence of CAD 66.6％ vs 45.8％,P＜0.05.Gensini score （28.98±23.87） vs （13.53±16.91）,P＜0.05].Incidence of mederate or severe OSAS had significant difference among group of single vessel disease,group of double-vessel disease and group of multi-vessel disease,incidence of moderate or severe OSAS was found positively correlation with number of coronary vessel lesions （R=0.376,P＜0.01）.（2）The Value PWV in group of moderate or severe OSAS was higher than in group of mild OSAS [PWV（1615.52±190.19） vs （1349.97±222.58）,P＜0.01],PWV correlate positively with AHI（R=0.40,P＜0.01）.（3）There was significant difference in PWV between CAD group and non-CAD group [PWV（1621.24±190.31） vs （1393.05±131.50）,P=0.00],furthermore,there were significant difference between single vessel group,double vessel group and multi-vessel group [PWV （1476.20±163.52） vs （1545.63±174.30）,（1545.63±174.30） vs （1680.10±215.72）,（1476.20±163.52） vs （1680.10±215.72）],there were positive relationship between PWV and the degree of coronary lesions（R =0.368,P＜0.01）,with Gensini score （R =0.60,P＜0.01）.Conclusion OSAS is an independent risk factor for CAD,there was positive relationship between the degree of OSAS and the degree of coronary lesions and PWV,since PWV was a marker of arteriosclerosis,we inferred that arteriosclerosis may be a mechanism of OSAS caused CAD.