阻塞性睡眠呼吸暂停综合征合并慢性阻塞性肺疾病患者血脂水平的临床研究

Clinical research of blood lipid level of obstructive sleep apnea hypopnea syndrome combined with COPD patients

目的探讨阻塞性睡眠呼吸暂停综合征（OSAHS）合并慢性阻塞性肺疾病（COPD）患者中血脂代谢的特点。方法选择福建医科大学附属闽东医院（以下简称“我院”）2012年1月-2014年1月收治入院的OSAHS合并COPD患者50例作为A组．另选择我院同期收治入院的单纯COPD患者50例作为B组，以及选择50例健康人作为C组，所有患者均行多导睡眠监测[包括呼吸暂停低通气指数（Am）、夜间最低血氧饱和度（L—SaO2）、夜间平均血氧饱和度（M—SaO2）、血氧饱和度〈90％时间占监测总时间的百分比（TS90）、呼吸相关微觉醒、最长呼吸暂停时间、最长低通气时间】，监测患者肺功能检查及动脉血气分析【包括FEV1占预计值百分比、FEV1/用力肺活量（FVC）、动脉血氧分压（PaO2）、动脉二氧化碳分压（PaCO2）、动脉血氧饱和度（SaO2）】，测量身高、体重、血压，并采集次日晨起外周血测定总胆固醇（TC）、高密度脂蛋白胆固醇（HDL—C）、低密度脂蛋白胆固醇（LDL—C）、三酰甘油（TG）等水平。结果A组患者AHI、TS90、呼吸相关微觉醒、最长呼吸暂停时间、最长低通气时间均高于B组和C组，而L—SaO2、M—SaO2均低于B组和C组，差异均有统计学意义（P〈0．01）；B组患者的AHI、TS90、呼吸相关微觉醒、最长呼吸暂停时间、最长低通气时间均高于C组，差异均有统计学意义（P〈0．01）；A组患者的FEV1／FVC、FEV1、SaO2、PaO2均低于B组和C组，而PaCO2水平高于B组和C组，且差异均有统计学意义（P〈0．01）；B组患者的SaO2水平低于C组，而PaCO2水平高于C组，差异均有统计学意义（P〈0．01）；A组患者的TC、LDL均高于B组和C组，而HDL水平低于C组，差异均有统计学意义（P〈0．01）；B组患者的TG水平高于C组，差异有统计学意义（P〈0．01）。结论OSAHS合并COPD患者TG、TC随之升高．同时血脂代谢异常的种类增加。脂代谢异常广泛参与了OSAS的发生、发展，并与多种并发症，尤其与心、脑血管疾病的发生有关联。故在临床工作中，对尿酸和脂代谢异常反复监测有益于对病情进展和预后的判断，可作为治疗参考。

Objective To study the obstructive sleep apnea hypopnea syndrome （OSAHS） in the patients with chronic obstructive pulmonary disease （COPD） combined the characteristics of blood lipid metabolism. Methods 50 patients with OSAHS with COPI） from January 2012 to January 2014 in the Fujian Mindong Hospital Affiliated to Medical University （＂our hospital＂ for short） were admitted as group A, another 50 cases simple COPD patients during the same period admitted in our hospital were chosen as group B, and 50 cases of healthy people were as group C, all patients were conducted with polysomnography, monitoring of patients with lung function and arterial blood gas analysis, measure the height, weight, blood pressure, and the next morning the determination of peripheral blood total cholesterol （TC）, highdensity lipoprotein cholesterol （PIDL-C）, low density lipoprotein cholesterol （LDL-C）, triglyceride （TG） levels were collected. Results In three groups of patients, AHI, average blood oxygen saturation （M-SaO2）, the lowest oxygen saturation （L-SaO2）, respiratory related micro awakening, the longest apnea time, low ventilation longest time were higher than those in group B and group C, with statistically significant differences （P 〈 0.01）; AHI, respiratory related micro awakening, the longest apnea time, low ventilation longest time of group B were higher than those in grouP C, with statistically significant differences （P 〈 0.01）; FEV1/FVC, FEV1, SaO2, PaO2 of group A were lower than those of group B and group C, but PaCO2 level was higher than that of group B and group C, with statistically significant differences （P 〈 0.01）; SaO2 level of group B was lower than that of group C, but PaCO2 level was higher than that of group C, with statistically significant differences （P 〈 0.01）; TC, LDL in patientsof group A were higher than those in group B and group C, and HDL levels were lower than that of group C, with statistically significant differences （P 〈 0.01）; TG level of group B was higher than that of group C, with statistically significant differences （P 〈 0.01）. COnclusion TG, TC of OSAHS with COPD patients will increase, types of dyslipidemia increases at the same time. Lipid metabolism disorder is widely involved in the occurrence and development of OSAS, and with a variety of complications, especially associ- ated with the occurrence of heart, cerebrovascular diseases. So in clinical work, uric acid and lipid metabolism disorder repeatedly monitoring is beneficial to the progression and prognosis of judgment, which can be taken as reference to treatment.