老年OSAHS并发急性脑梗死患者决策功能障碍与血清低氧诱导因子-1的关系

Relationship between decision-making dysfunction and serum hypoxia inducible factor-1 in elderly patients with obstructive sleep apnea hypopnea syndrome complicated by acute cerebral infarction

目的分析老年阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)并发急性脑梗死患者决策功能障碍血清低氧诱导因子-1(HIF-1)的相关性,为OSAHS急性脑梗死患者认知障碍的早期识别提供依据。方法以2013年3月-2014年10月华北理工大学附属医院确诊的328例OSAHS并发脑梗死患者为研究对象。根据爱荷华赌博任务(IGT)评测分为无和决策障碍组,对两组患者年龄、性别、饮酒、文化程度、梗死部位、OSAHS程度、是否合并慢性疾病以及HIF-1等决策障碍的潜在因素进行单因素和多因素分析;运用χ~2检验和Pearson法分析决策功能障碍与血清HIF-1的相关性。结果单因素分析和logistic回归分析显示梗死部位在基底节(OR=2.227,95%CI:1.507~3.291,P=0.000)、OSAHS程度高(OR=1.676,95%CI:1.194~2.353,P=0.003)、合并慢性疾病(OR=1.656,95%CI:1.120~2.449,P=0.011)、高水平HIF-1(OR=1.701,95%CI:1.147~2.764,P=0.032)是OSAHS并发急性脑梗死患者决策障碍的主要危险因素;高HIF-1水平额叶梗死、轻度OSAHS、合并有慢性疾病的OSAHS并发急性脑梗死患者决策功能障碍发生风险,显著高于非高HIF-1水平额叶梗死、轻度OSAHS、合并有慢性疾病的患者(RR=1.412、1.350、1.264),差异有统计学意义(均P<0.01)。Pearson相关分析显示HIF-1水平与IGT各阶段及总分评分呈显著负相关(均P<0.05)。结论梗死部位、OSAHS程度、慢性疾病以及高HIF-1水平是老年OSAHS并发急性脑梗死患者决策功能障碍的独立危险因素;HIF-1水平与决策障碍程度有关。

Objective To analyze the correlation between decision-making dysfunction and serum hypoxia inducible factor-1 （ HIF- 1 ） in elderly patients with obstructive sleep apnea hypopnea syndrome （ OSAHS ） complicated by acute cerebral infarction （ ACI ） , so as to provide a basis for early identifying decision-making dysfunction in them. Methods Three hundred and twen- ty-eight OSAHS patients with ACI confirmed in the Affliated Hospital of North China University of Science and Technology from March 2013 to October 2014 were recruited as the research objects, and divided into decisi0n-making non-impairment group and decision-making impairment group according to the assessment of Iowa Gambling Task （ IGT ）. Univariate and multivariate analyses were performed to analyze the potential factors of decision-making dysfunction, including age, gender, alcohol consumption, edu- cation background, infarct site, OSAHS degree, complication with chronic diseases and serum HIF-1. Chi square test and Pearson anlaysis were employed for analyzing the correlation between decision-making dysfunction and serum HIF-1. Results Univari- ate and multivariate regression analyses displayed that infarct site at basal ganglia （OR = 2.227, 95% CI： 1.507-3.291, P = 0.000） , high OSAHS degree （OR=1.676, 95%CI：1.194-2.353, P=0.003） , complication with chronic diseases （OR= 1.656, 95%CI： 1. 120-2.449, P=0.011 ） and high HIF-1 level （OR= 1.701, 95%CI： 1.147-2.764, P=0.032） were the major risk factors for decision-making impairment in the OSAHS patients complicated by ACl. Those who had frontal lobe infarction, mild OSAHS or complication of chronic diseases had higher risk of decision-making dysfunction in the subgroup with higher serum HIF- 1 level than that with lower one （RR= 1.412, RR= 1.350, RR= 1.264, all P〈0.O1）. Pearson correlation analysis revealed that serum HIF -1 level was significantly negatively correlated with the stage score and total score of IGT （all P〈0.05）. Conclusions Infarct site, OSAHS degree, chronic diseases and high level of serum HIF- 1 are independent risk factors for decision-making dysfunction in the elderly patients with OSAHS complicated by ACI. Serum HIF-1 level is related to the degree of decision-making dysfunction.