阻塞性睡眠呼吸暂停低通气综合征患者冠状动脉病变特点及其影响因素研究

Characteristics and Influence Factors of Coronary Artery Lesions in Patients with Obstructive Sleep Apnea Hypopnea Syndrome

目的分析阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者冠状动脉病变特点及其影响因素。方法选取2013年6月—2014年6月在新疆医科大学第一附属医院心脏中心住院完善睡眠呼吸监测并行冠状动脉造影的患者120例,根据呼吸暂停低通气指数（AHI）将患者分为对照组（AHI〈10次/h）25例,轻度组（AHI 10~15次/h）32例,中重度组（AHI〉15次/h）63例。收集患者一般资料,如性别、年龄、吸烟史、饮酒史、高血压、糖尿病检出率,并测定三酰甘油（TG）、总胆固醇（TC）、空腹血糖（FBG）水平。对患者进行睡眠呼吸监测,记录最低血氧饱和度（LSaO2）;并进行冠状动脉造影,对冠状动脉的主要血管左主干（LM）、左前降支（LAD）、左回旋支（LCX）、右冠状动脉（RCA）进行评价,将其中任意1支血管内径狭窄≥50%诊断为冠心病。根据累及的主要冠状动脉支数,诊断为单支病变及多支病变（病变累及2支动脉及以上者,定义为多支病变）。采用多因素Logistic回归分析影响OSAHS患者合并冠心病、单支病变及多支病变的因素。结果对照组、轻度组和中重度组性别、吸烟率、饮酒率、体质指数（BMI）、TG、TC、24 h平均收缩压（24 hSBP）、24 h平均舒张压（24 hDBP）比较,差异均无统计学意义（P〉0.05）。3组年龄比较,差异有统计学意义（P〈0.05）,其中中重度组年龄高于轻度组（P〈0.05）。3组LM、LCX、多支病变发生率比较,差异均无统计学意义（P〉0.05）;3组LSaO2及LAD、RCA、单支病变、冠心病发生率比较,差异均有统计学意义（P〈0.05）,其中中重度组LSaO2均低于对照组和轻度组（P〈0.05）,LAD、RCA、单支病变、冠心病发生率均高于对照组和轻度组（P〈0.01）。以冠心病、单支病变、多支病变为因变量,以性别、吸烟、饮酒、年龄、高血压、糖尿病、AHI、LSaO2为自变量,Logistic回归分析结果显示,饮酒、年龄、AHI与OSAHS患者合并冠心病有回归关系（P〈0.05）;饮酒、AHI与OSAHS患者合并单支病变有回归关系（P〈0.05）;年龄与OSAHS患者合并多支病变有回归关系（P〈0.05）。结论随着OSAHS患者病情加重,发生冠心病的可能性增加,主要表现为发生单支病变,其中LAD及RCA为最易受累血管。饮酒、年龄、AHI为OSAHS患者合并冠心病的危险因素;饮酒、AHI为OSAHS患者合并单支病变的危险因素;年龄为OSAHA患者合并多支病变的危险因素。

Objective To analyses the characteristics and its influence factors of coronary artery lesions in patients with obstructive sleep apnea hypopnea syndrome（ OSAHS）. Methods 120 patients were selected which were undergoing sleep apnea monitoring and coronary angiography in the Heart Center of the First Affiliated Hospital of Xinjiang Medical University form June 2013 to June 2014. They were divided into 3 groups according to apnea hypopnea index（ AHI） ： control group（ AHI 〈10 times /h,n = 25）,mild group（ AHI 10- 15 times /h,n = 32）,and moderate- severe group（ AHI〉 15 times /h,n = 63）.Baseline data of patients was collected,such as gender,age,smoking history,alcohol consumption,hypertension,detection rate of diabetes and the detection of triglyceride（ TG）,total cholesterol（ TC）,fasting blood glucose（ FBG） levels. In addition,patients were undergoing sleep apnea monitoring and recording the lowest oxygen saturation（ LSaO2）. Moreover,the left main coronary artery（ LM）,left anterior descending artery（ LAD）,left circumflex artery（ LCX） and right coronary artery（ RCA） by coronary moving shadow were evaluated,and diagnosis of coronary heart disease in which any one ≥50% luminal diameter stenosis. According to the number of damaged major coronary branch,they were diagnosed as single vessel or multiple vessel disease（ damaged major coronary branch up to two or more,defined as multiple vessel disease）. The data were analyzed by Logistic regression analysis to assess the characteristics of OSAHS patients with coronary artery disease and its influence factors. Results The basic data comparison： there was no significance in gender,smoking,drinking,BMI,TG,TC,24 hSBP,24 hDBP among the three groups（ P〉 0. 05）,but the age was statistically significant difference,which in moderate- severe group was older than in mild group（ P〉0. 05）. The results of coronary angiography showed that three groups had significant differences in LSaO2,LAD,RCA,single vessel disease and the incidence of coronary heart disease（ P〈 0.05）,but no differences in LM,LCX and multiple vessel disease（ P〈 0. 05）. The LAD,RCA,single vessel disease and incidence of coronary heart disease in the moderate- severe group was higher than those in mild group and control group（ P〈 0. 01）,and LSaO2 in moderate- severe group was lower than that in mild group and control group（ P〈 0. 05）. Multivariate Logistic regression analysis showed that drinking,age,AHI were the main risk factors of coronary artery disease（ P〈 0. 05）. In addition,alcohol,AHI were the main risk factors for single vessel disease（ P〈 0. 05）,and age was the main risk factor for multiple vessel disease（ P〈 0. 05）. Conclusion With the OSAHS disease aggravated gradually,the risk of suffering from coronary heart disease is increased. The main clinical feature is single vessel disease,and the LAD and RCA is much easier to affected. Drinking,age and AHI are the main risk factors of OSAHS patients with coronary artery disease. Drinking and AHI are major risk factors for single vessel disease. And age is the main risk factor for multiple vessel disease.