阻塞性睡眠呼吸暂停综合征患者早期左心室功能改变

Early changes of left ventricular function in patients with obstructive sleep apnea syndrome

目的探讨阻塞性睡眠呼吸暂停综合征(OSAS)患者左心室形态改变前收缩和舒张功能改变。方法将111例OSAS患者分为OSAS伴左心室肥厚(LVH)组(29例)及OSAS无LVH组(82例),同时设正常对照组50名,行常规超声心动图及二维斑点追踪成像(2D-STI)检查,比较3组间常规超声心动图及2D-STI指标的差异,分析超声指标与临床指标的相关性。结果 OSAS伴LVH组与其他2组相比左心室质量指数(LVMI)、室间隔舒张末期厚度(IVST)、左心室后壁舒张末期厚度(PWT)、左心室舒张末期内径(LVIDd)、二尖瓣舒张早期峰值流速与二尖瓣环舒张早期运动速度比值(E/e')及左心房容积指数(LAVI)增大(P均<0.05),室间隔及左心室侧壁二尖瓣环舒张早期运动速度(e')减小(P均<0.05);其二尖瓣环收缩期运动速度(s')小于正常对照组(P=0.013)。OSAS伴LVH组与其他2组相比左心室整体纵向收缩期应变(S)及舒张早期应变率(SRE)减小(P均<0.05),二尖瓣舒张早期峰值血流速度与舒张早期应变率比值(E/SR_E)增大(P均<0.05),其左心室整体纵向收缩期应变率(SR_S)小于正常对照组(P=0.001)。与正常对照组比较,OSAS无LVH组S、SR_S及SR_E减小(P均<0.05),E/SR_E增大(P<0.001)。S、E/SR_E均与睡眠呼吸暂停低通气指数独立相关(P均<0.05),LVMI与平均血氧饱和度独立相关(标准化系数=-0.299,t=-3.273,P=0.001)。结论 OSAS可影响左心室结构及功能,在左心室形态发生明显改变前,LV收缩及舒张功能已受损。

Objective To investigate the changes of left ventricular systolic and diastolic function before left ventricular morphologic changes in obstructive sleep apnea syndrome（OSAS）patients.Methods A total of 111 OSAS patients were divided into left ventricular hypertrophy（LVH）group（n=29）and non-LVH group（n=82）.Meanwhile,50 healthy subjects were enrolled as normal control group.Routine echocardiography and two-dimensional speckle tracking imaging（2 D-STI）were performed.The differences of conventional echocardiography and 2 D-STI parameters were compared among the three groups.The correlations between echocardiography and clinical parameters were analyzed.Results Compared with those of the other 2 groups,left ventricular mass index（LVMI）,diastolic thickness of interventricular septum（IVST）,diastolic ventricular posterior wall thickness（PWT）,left ventricular internal diastolic dimension（LVIDd）,the ratio between early diastolic peak velocity of mitral valve and early diastolic velocity of mitral annular（E/e＇）and left atrial volume index（LAVI）increased（all P〈0.05）,and mitral annular early diastolic velocity（e＇）at interventricular septum and lateral wall decreased in LVH group（all P〈0.05）.The mitral annular systolic velocity（s＇）in LVH group was less than that in normal control group（P =0.013）.Compared with those of the other 2 groups,left ventricular global longitudinal systolic strain（S）and early diastolic strain rate（SR_E）decreased（all P〈0.05）,and the ratio of early diastolic peak velocity of mitral valve to SR_E（E/SR_E）increased in LVH group（both P〈0.05）.Compared with normal control group,systolic strain rate（SRS）decreased in LVH group（P=0.001）.S,SRS,SR_E in non-LVH group were less than those in normal control group（all P〈0.05）,and E/SR_E was higher than that in normal control group（P〈0.001）.S,E/SR_E were independently associated with apnea hypopnea index（both P〈0.05）.LVMI was independently associated with mean arterial oxygen saturation（β=-0.299,t=-3.273,P=0.001）.Conclusion OSAS can affect the structure and functions of left ventricular independently.The systolic and diastolic functions of left ventricular have been impaired before morphology changed.