阻塞性睡眠呼吸暂停综合征与左心室重构相关性的多因素分析

Multi-factor Analysis for the Correlation Between Obstructive Sleep Apnea Syndrome and Left Ventricular Remodeling

目的:阻塞性睡眠呼吸暂停综合征(OSAS)可引起左心室重构,但OSAS是否是左心室重构的独立危险因素尚有争议。本研究旨在探讨OSAS与左心室重构的相关性。方法:选取2006-01至2012-09于本院七病房行睡眠呼吸监测的患者1 440例,符合入选标准的共972例,以呼吸暂停低通气指数(AHI)<5次/小时为对照组(n=260),AHI≥5次/小时为OSAS组(n=712),分别根据AHI将OSAS组分为两部分患者:OSAS轻度患者(5≤AHI≤15次/小时)和OSAS中重度患者(AHI>15次/小时),根据有无高血压病史及高血压患病时间分为四个亚组:无高血压亚组217例,初诊高血压亚组130例(病程<2年),中长期高血压亚组324例(2年≤高血压病程<10年),长期高血压亚组301例(高血压病程≥10年)。所有患者均行M型二维超声心动图检查,分别测量左心室室间隔厚度(IVST),左心室后壁厚度(LVPWT),左心室舒张末期容积(LVIDd)。根据相应公式,计算左心室质量(LVM)、左心室质量指数(LVMI)及相对室壁厚度(RWT),并将心脏构型分为正常构型、向心性重构、向心性肥厚、离心性肥厚四类。结果:①OSAS组平均LVMI[(102.30±29.54)g/m2]大于对照组平均LVMI[(96.56±25.90)g/m2,P=0.002],OSAS组IVST[(10.25±1.70)mm]、LVPWT[(9.9±1.40)mm]、LVIDd[(48.88±5.10)mm]及LVM[(211.41±63.38)g]均分别明显大于对照组[(9.84±1.77)mm、(9.58±1.30)mm、(47.41±4.53)mm、(190.03±57.32)g],差别均有统计学意义(P<0.001)。②中重度OSAS患者IVST、LVM明显大于轻度OSAS患者[IVST(10.37±1.72)mm vs(10.25±1.65)mm,P=0.010;LVM(215.29±62.16)g vs(205.01±64.95)g,P=0.011]。③OSAS组的左心室重塑发生率(45.8%)大于对照组(40.0%),但无统计学意义(P=0.062),中重度OSAS患者左心室重塑发生率(49.2%)大于轻度OSAS患者(40.1%,P=0.011)。④OSAS组左心室重塑类型多表现为向心性重构(32.9%)。⑤多元线性回归分析显示LVM与AHI正相关(r=0.125,P=0.009)。结论:OSAS可加剧心室重塑,这种影响在中重度OSAS中尤为显著,AHI可能是左心室重构的独立危险因素。

Objective： Obstructive sleep apnea syndrome （OSAS） may cause left ventricular remodeling, while it is controversial whether OSAS is the independent risk factor for the remodeling, and we explored the relationship between OSAS and left ventricular remodeling. Methods： A total of 1440 OSAS patients were screened in our hospital from 2006-01 to 2012-09 and 972 with matched criteria were summarized. The patients were divided into 2 groups, Control group, n=260 patients with AHI〈5/hr and OSAS group, n=712 patients with AHI ≥ 5/hr; the OSAS patients were further divided into another 2 subgroups, Mild group, the patients with 5≤ AHI ≤ 15/hr and Moderate to severe group, the patients with AHI〉15/hr. Doppler ultrasound was conducted to examine the cardiac morphology and function. Results： （1） OSAS group had the higher LVMI （102.30±29.54） g/m2 than that in Control group （96.56±25.90） g/m2, P=0.002; higher IVST （10.25±1.70） mm, LVPWT （9.9±1.40） mm, LVIDd （48.88±5.10） mm and LVM （211.41±63.38） g than those in Control group （9.84±1.77） mm, （9.58±1.30） ram, （47.41±4.53） mm and （190.03±57.32） g, all P〈0.001. （2） Moderate to severe group showed higher IVST and LVM than those in Mild group, （10.37±1.72） mm vs （10.25±1.65） mm, P=0.010 and （215.29±62.16） g vs （205.01 ±64.95） g, P=0.011 .（3） The prevalence of left ventricular remodeling in OSAS group was similar to Control group, 45.8% vs 40.0%, P=0.062; in Moderate to severe group was higher than that in Mild group, 49.2% vs 40.1%, P=0.011. （4） The model of left ventricular remodeling in OSAS group was more in concentric remodeling （32.9%）. （5） Multi-linear regression analysis indicated that LVM was positively related to AHI （r=0.125, P=0.009）. Conclusion： OSAS may aggravate left ventricular remodeling which was particularly obvious in moderate to severe OSAS patients. AHI might be an independent risk factor for the remodeling.