阻塞性睡眠呼吸暂停低通气综合征合并慢性阻塞性肺疾病患者脂质代谢指标及血栓前状态指标的分析

Analysis on indexes of lipid metabolism and status indicators before blood clots in patients with obstructive sleep apnea hypoventilation syndrome accompanied chronic obstructive pulmonary disease

目的:观察阻塞性睡眠呼吸暂停低通气综合征(0SAHS)合并慢性阻塞性肺疾病(COPD)患者的脂质代谢指标及血栓前状态指标的变化,探讨其是否存在脂质代谢紊乱及血液高凝状态。方法:0SAHS合并COPD患者被纳入重叠综合征(OS)组,共30例,0SAHS组41例,COPD组48例,健康对照组45例。所有研究对象进行肺功能检查,血标本检测,包括甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、非高密度脂蛋白胆固醇(non-HDL-C)、脂蛋白(α)(LPα)、血清载脂蛋白A1(apoA1)、血清载脂蛋白B(apoB)、纤维蛋白原(FIB)、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、血浆D-二聚体(D-Dimmer)、同型半胱氨酸(Hcy)。应用SPSSl8.0软件进行统计分析。结果:OS组、0SAHS组apoA1、HDL-C与健康对照组、COPD组比较明显降低(均P<0.05);OS组apoA1、HDL-C与0SAHS组比较明显降低(均P<0.05)。OS组、0SAHS组LPα、apoB、TG、TC、LDL-C、non-HDL-C与健康对照组、COPD组比较明显增高(均P<0.05);OS组LPα、apoB、TG、TC、LDL-C、non-HDL-C与0SAHS组比较明显增高(均P<0.05)。COPD组、健康对照组间LPα、apoA1、apoB、TG、TC、HDL-C、LDL-C、non-HDL-C差异无统计学意义(均P>0.05)。OS组、0SAHS组及COPD组的PT、APTT、TT与健康对照组比较明显缩短(P<0.05),OS组的PT、APTT、TT与0SAHS组及COPD组比较明显缩短(P<0.05)。OS组、0SAHS组及COPD组的FIB、D-Dimmer、Hcy含量与健康对照组比较明显增高(均P<0.05),OS组的FIB、D-Dimmer、Hcy含量与0SAHS组和COPD组比较明显增高(P<0.05)。0SAHS组和COPD组的PT、APTT、TT、FIB、D-Dimmer、Hcy差异无统计学意义(P>0.05)。结论:OS、0SAHS可能导致血浆脂质代谢紊乱,COPD、0SAHS及OS患者均存在血液高凝状态,而OS患者尤为明显。

Objective： To observe the changes of indexes of lipid metabolism and status indicators before blood clots in patients with OSAHS （obstructive sleep apnea hypoventilation syndrome） accompanied COPD （chronic obstructive pulmonary disease）, and whether lipid metabolism disorder and hypercoagnlable state exist in them is discussed. Methods： Patients with OSAHS accompanied COPD were brought into OS （overlap syndrome） group. There were 30 cases in OS group, 41 cases in OSAHS group, 48 cases in COPD group and 45 cases in control group separately. Puhnonary function test and blood specimen detection were carried in all in- dividuals. Blood specimen detection included triglyceride （TG）, total cholesterol （TC）, high density lipoprotein- cholesterol （HDL-C）, low density lipoprotein-cholesterol （LDL-C）, non-high density lipoprotein-cholesterol （non-HDL-C）, lipoprotein （ct） （Lpct）, apolipoprotein A1 （apoA1）, apolipoprotein B （apoB）, fibrinogen （FIB）, activated partial thromboplastin time （APTT）, prothrombin time （PT）, thrombin time （TT）, plasma D-dimmer （D-Dimmer） and homocysteine （Hey）. Statistic analysis was carried with SPSS 18.0. ResuRs： apoA1 and HDL- C in OS group and 0SAHS group were less than those in control group and COPD group significantly （P〈0.05）. apoA1 and HDL-C in OS group were less than those in 0SAHS group significantly （P〈0.05）. LPα, apoB, TG, TC, LDL-C and N-HDL-C in OS group and 0SAHS group were more than those in control group and COPD group significantly （P〈0.05）. LPct, apoB, TG, TC, LDL-C and non-HDL-C of OS group were more than those in 0SAHS group significantly （P〈0.05）. There was no significant difference between control group and COPD group in apoA1, HDL-C, LPct, apoB, TG, TC, LDL-C and non-HDL-C （P〉0.05）. PT, APTT and TT in OS group, 0SAHS group and COPD group were less than those in control group significantly （P〈0.05）. PT, APTT and TT in 0S group were less than those in 0SAHS group and COPD group significantly （P〈0.05）. FIB, D-Dimmer and Hcy in OS group, 0SAHS group and COPD group were more than those in control group significantly （P〈0.05）. FIB, D-Dimmer and Hcy in OS group were more than those in 0SAHS group and COPD group significantly （P〈0.05）. There was no significant difference between 0SAHS group and COPD group in PT, APTT, TT, FIB, D-Dimmer, Hcy （P〉0.05）. Coneluslon： OSAHS and OS can induce plasma lipid metabolism disorder, and hypercoagnlable state exist in patients with COPD or 0SAHS or OS, and oatients with OS is obvious relatively.