手术对阻塞性睡眠呼吸暂停低通气综合征患者血脂代谢变化的临床观察

Serum lipid changes in obstructive sleep apnea hypopnea syndrome patients underwent airway surgery

目的探讨能否根据阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者上气道手术后机体血脂的改善状况作为直观、有效评估手术疗效的方法之一。方法回顾性分析2010~2013年间北京朝阳医院耳鼻咽喉头颈外科手术治疗的OSAHS患者血脂资料,筛选出具有手术前未治疗期、术前围手术期及术后恢复期后三次血脂检查结果并且期间无降脂类药物使用史的患者共19例,分析血脂数值在观察期内的变化特点。结果手术前未治疗期的血脂检查时间为(12.5±5.6)个月,手术恢复期后血脂检查时间(11.8±6.2)个月。OSAHS患者手术前未治疗期,手术时及手术恢复期后,均无降脂药物服用史情况下,血清总胆固醇(TC)含量变化差异有统计学意义(F=9.03,P=0.000 7);手术前未治疗期和手术时比较,差异有统计学意义(P<0.001),手术时与手术恢复期后,差异有统计学意义(P=0.017);血清脂蛋白(a)[LP(a)]含量变化差异有统计学意义(F=5.49,P=0.009),手术前未治疗期和手术时比较,差异有统计学意义(P=0.007),手术时与手术恢复期后,差异有统计学意义(P=0.007)。结论 OSAHS患者间断性缺氧可以导致机体血脂升高,手术治疗可改善OSAHS患者存在的脂质代谢紊乱状态,血清总胆固醇和血清脂蛋白(a)均是对机体低氧敏感的指标,早期发现、积极治疗OSAHS对预防治疗心血管疾病意义重要,更多的心血管指标建议被探索和评估手术对OSAHS改善的证据。

Objective To investigate the changes of lipid profiles in patients with obstructive sleep apnea hypopnea syndrome（ OSAHS） before and after upper airway surgery,and to explore whether lipid detection can be used as an intuitive and effective way to evaluate the efficacy of surgery. Methods We performed a retrospective reviewof adult OSAHS patients who underwent surgery at Beijing Chaoyang Hospital during 2010 to 2013 with available perioperative serum lipid profiles,and selected the data of patients who did not use lipid-lowering medications during this period. We set up preoperative period,perioperativeperiod and follow-up period as three observation point. Results A total of 19 patients were enrolled. Preoperative blood lipid examination time was（ 12. 5 ± 5. 6） months and the follow-up was（ 11. 8 ± 6. 2） months. There was significant difference in total cholesterol serum（ TC） levels and Lipoprotein（ a） levels in OSAHS patients among the three observation periods（ FTC= 9. 03,PTC= 0. 000 7; FLP（ a）= 5. 49,PLP（ a）= 0. 009）.We set the perioperative period as the baseline. Both TC and LP（ a） are significantly different when compare the preoperative and follow-upperiod to perioperative period（ all P 〈0. 05）. Conclusion OSAHS with intermittent hypoxia can lead to blood serum lipids disorder,which can be improved with surgical treatment. TC and LP（ a） are both sensitive indicator to hypoxia. Early detection and treatment of OSAHS are essential for the prevention and treatment of cardiovascular diseases. We suggest that more cardiovascular indicators should be explored to evaluate the effectiveness of surgery.