老年哮喘患者发生OSAHS的危险因素分析

Risk factors of asthma complicated with obstructive sleep apnea hypopnea syndrome in elderly patients

目的通过对比支气管哮喘老年患者合并阻塞性睡眠呼吸暂停低通气综合征的临床资料及肺功能指标，来探讨哮喘合并OSAHS的危险因素，为临床诊治提供依据。方法研究对象病例选取均来自本院呼吸内科门诊或住院老年（〉65岁）哮喘患者72例，经过本院伦理委员会审核通过，患者或家属同意，其中合并OSAHS患者42例（58．33％），未合并OSAHS患者30例（41．67％），同时选取同一时间来本院体检健康人37例作为对照组，详细收集所有患者的临床资料，包括性别、年龄、身高、体重及过敏性鼻炎史，测定每位患者的最大呼气流量-容积曲线和肺容量，记录肺功能指标，对比两组间BMI、过敏性鼻炎史以及肺功能指标的差异，对老年哮喘合并OSAHS与性别、年龄、BMI、过敏性鼻炎史以及肺功能指标的关系采用多因素Logistic回归分析。结果三组患者在性别方面差异无统计学意义（P〉0．05），在年龄、BMI上差异有统计学意义（P〈0．05），经LSD法测定，与对照组比，OSAHS组在年龄上差异存在统计学意义（P〈0．05），无OSAHS组和OSAHS组在BMI上差异有统计学意义（P〈0．05）；两组间在病程、BMI、过敏性鼻炎史及肺功能指标（MMEF、IC、PD20FEV1）上差异有统计学意义（P〈0．05），而在性别、年龄及肺功能指标（FEV1、PEF、TLC、FEV，／FVC）指标上差异无统计学意义（P〉0．05）；Logistic分析显示病程、BMI在两组间差异有统计学意义（P〈0．05），老年哮喘患者病程增加1年合并OSAHS危险性增加111％（OR=2．11，95％CI：1．27—3．35，P〈0．05），BMI增加1kg／m。危险性增加124％（OR=2．24，95％CI：I．31—5．99，P〈0．05）。结论老年哮喘合并OSAHS发生率高，病程、BMI均为老年哮喘的高危因素，对肥胖和病程较长的老年患者应密切注意病情变化。

Objective To explore the risk factors of asthma complicated with obstructive sleep apnea hypopnea syndrome （OSAHS） and to provide some references for its diagnosis and treatment comparing the patients＇ clinical data and lung function indicators with the asthma elderly patients without OSAHS＇s and healthy objects＇. Methods 72 elderly patients （over 65 years old） with asthma were selected from the out- and in-patients of our hospital as study objects. This study was verified and qualified by the ethics committee of our hospital and known and agreed by the patients and their family members. Among the 72 patients, 42 （58.33%） complicated with OSAHS and 30 （41.67%） without. 37 healthy objects undergoing physical examination at our hospital during the same period were selected as a control group. All the objects＇ clinical data, gender, age, height, weight, and history of allergic rhinitis, were collected. The maximum expiratory flow volume curve and each one＇s lung capacity were determined. Their pulmonary function indicators were recorded. The differences in BMI, allergy rhinitis history, and lung function indicators were compared. The correlation of asthma complicated with OSAHS in elderly patients with gender, age, BMI, history of allergic rhinitis, and lung function indicators was analyzed by logistic regression analysis. Logistic. Results There were no statistical differences in gender （P〈0.05） and were in age and BMI（P〈0.05） between these three groups. LSD determination showed that there was statistical difference in age between the control group and the OSAHS group and was in BMI between the no-OSAHS group and OSAHS group （P〈0.05）. There were statistical differences in disease course, BMI, history of allergic rhinitis, MMEE IC, and PD20FEV1 （P〈0.05） and no in gender, age, FEV1, PEF, TLC, and FEV1/FVC （P 〉 0.05） between these two groups. Logistic analysis showed that there were statistical differences in disease course and BMI between these two groups （P〈0.05）; if the disease course of elderly patients with asthma increased 1 year, the risk of complication with OSAHS would increase 111% （OR=2.11, 95% CI 1.27-3.35, P〈0.05） and if the BMI increased I kg/m2, the risk would increase 124% （OR=2.24, 95% CI 1.31-5.99, P〈0.05）. Conclusions The incidence of OSAHS in elderly patients with asthma is high. Disease course and BMI are high risk factors in elderly patients with asthma. Fat elderly asthma patients with long disease course and should pay close attention to the disease changes.