纤维鼻咽镜与磁共振成像定位男性阻塞性睡眠呼吸暂停低通气综合征患者上呼吸道阻塞平面的一致性研究

Localization of Upper Airway Obstruction in Male OSAHS Patients:a Comparative Study of Fibre Nasopharyngoscopy and Magnetic Resonance Imaging

目的探讨不同严重程度男性阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者纤维鼻咽镜与磁共振成像(MRI)测量上呼吸道指标差异和阻塞平面情况,分析两种评价方法对患者上呼吸道阻塞平面定位的相关性与一致性。方法选取2014年5月—2015年12月金华市中心医院耳鼻咽喉头颈外科就诊的93例男性OSAHS患者,包括轻度组32例、中度组31例、重度组30例。纤维鼻咽镜检查软腭后区、舌后区、会厌后区塌陷度,MRI测量软腭后区、舌后区、会厌后区横截面积、左右径,前后径、咽侧壁厚度等。采用SPSS 15.0软件分析两种评价方法的一致性。结果 3组OSAHS患者软腭后区、舌后区、会厌后区塌陷度,横截面积,左右径,前后径及会厌后区咽侧壁厚度比较,差异均有统计学意义(P<0.05)。相关性分析结果显示,轻度组会厌后区塌陷度与横截面积呈正相关(r=0.53,P=0.002),中度组会厌后区塌陷度与横截面积呈负相关(r=-0.53,P=0.002)。Kappa分析结果显示,重度组会厌后区纤维鼻咽镜检查与MRI测量评定阻塞平面Kappa=0.390(P=0.007)。结论纤维鼻咽镜检查与MRI测量能够分别反映不同病情严重程度OSAHS患者上呼吸道软组织顺应性与解剖学特征的差异,两种检查方法对患者上呼吸道阻塞平面定位缺乏良好的相关性及一致性,临床上应联合应用这两种检查方法全面评估患者上呼吸道阻塞情况。

Objective To investigate the results of upper airway parameters and localization of upper airway obstruction in males with varying degrees of obstructive sleep apnea hypopnea syndrome（OSAHS） detected by fibre nasopharyngoscopy（FN） versus magnetic resonance imaging（MRI）,and based on this,to analyze the correlation and consistency of the two methods for the localization of upper airway obstruction in these patients.Methods We enrolled 93 OSAHS patients who received treatment in Department of Otolaryngology,Head and Neck Surgery,Jinhua Central Hospital from May 2014 to December 2015,including 32 with mild OSAHS（mild group）,31 with moderate OSAHS（moderate group）,and 30 with severe OSAHS（severe group）.The collapse degree of the hinder parts of the soft palate,the tongue and epiglottis was measured with FN.The cross-sectional area,left-right dimension and front-back dimension of the hinder part and thickness of pharyngeal wall of the soft palate,the tongue and the epiglottis were measured by MRI.SPSS 15.0 statistical software was applied to analyze the measurement results of the two methods.Results The collapse degree,cross-sectional area,left-right dimension and front-back dimension of the hinder part of the soft palate,the tongue and epiglottis,and the lateral wall thickness of the epiglottis differed significantly between the three groups（P0.05）.Pearson correlation analysis found that,the collapse degree and the cross-sectional area of hinder part of epiglottis were positively correlated in the mild group（r=0.53,P=0.002）,while they were negatively correlated in the moderate group（r=-0.53,P=0.002）.The results of localization of upper airway obstruction by FN were consistency with MRI（Kappa=0.390,P=0.007）.Conclusion Both FN and MRI can detect the airway soft tissue compliance and anatomical features in patients with varying degrees of OSAHS,but for the localization of upper airway obstruction,they have no correlation and consistency.Therefore,in order to comprehensively assess the upper airway obstruction in these patients,these two methods can be used together.