阻塞性睡眠呼吸暂停低通气综合征患者血栓弹力图的变化及影响因素分析

Analysis of Changes of Thrombelastogram and Influence Factors of Patients with Obstructive Sleep Apnea Hypopnea Syndrome

目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血栓弹力图(TEG)指标的变化及影响因素。方法方便选择2014年7月—2016年4月福建医科大学附属第一医院收治的多导睡眠呼吸监测(PSG)的鼾症患者120例,记录其PSG数据,次晨采集空腹静脉血,检测血清TEG、血脂情况。根据AHI,分为非OSAHS组、轻度OSAHS组、中度OSAHS组、重度OSAHS组,对比各组患者TEG指标,并分析影响因素。结果非OSAHS组与OSAHS组在年龄、体质量指数(BMI)、颈围、腰围、呼吸暂停低通气指数(AHI)、呼吸暂停低通气时间指数(AHTI)、氧减指数(ODI)等方面差异有统计学意义(P<0.05),但在性别、吸烟、服药史、身高、高密度脂蛋白、载脂蛋白A1等方面差异无统计学意义(P>0.05)。各组TEG指标的比较:中、重度OSAHS组R时间[4.6(4.4~5.0)、4.7(4.3~5.1)min]较非OSAHS组[6.4(5.9~6.8)min]及轻度OSAHS组[5.2(5.0~5.4)min]明显缩短(P<0.05),轻、中重度OSAHS组K时间较非OSAHS组缩短(1.7±0.4)vs(1.6±0.30)vs(1.6±0.20)vs(2.1±0.30)min,(P<0.001),α角更大(68.3±4.20)°vs(68.1±3.50)°vs(66.4±3.70)°vs(60.5±4.20)°,(P<0.001),中、重度OSAHS组MA[(61.2±2.60)、60.2±3.00)mm]较非OSAHS组[(57.4±2.40)mm]增加(P<0.01)。TEG指标的Spearman相关分析:(1)R时间与AHI、AHTI、TS90%、ODI呈负相关;(2)K时间与AHI、AHTI、TS90%呈负相关;(3)α角与年龄、腰围、总胆固醇、极低密度脂蛋白呈正相关;(4)MA与BMI、颈围、腰围、TS90%呈正相关。结论 OSAHS患者TEG指标与反应OSAHS病情指标相关性较好,为评估OSAHS患者高凝状态提供了依据,具有一定的应用价值。

Objective To study the changes of thrombelastogram and influence factors of patients with obstructive sleep apnea hypopnea syndrome.Methods 120 cases of PSG snoring patients admitted and treated in our hospital from July 2014 to April 2016 were convenient selected,and the PSG data were recorded,and the fasting venous blood was collected in the next morning,and the serum TEG,and blood liquid were tested,and the patients were divided into non-OSAHS group,mild-OSAHS group,moderate-OSAHS group and severe-OSAHS group and the TEG indicators of each group was compared and the influence factors were analyzed.Results The differences in the age,BMI,neck circumference,waist circuferrence,AHI,AHTI,ODI between the non-OSAHS group and OSAHS group were statistically significant(P<0.05),but the differences in the gender,smoking,medication history,height,high density lipoprotein,apolipoprotein A1 were not statistically significant(P>0.05),and the R time in the middle and severe OSAHS group were obviously shortened compared with that in the non-OSAHS group and mild OSAHS group[(4.6(4.4~5.0),4.7(4.3~5.1)min)vs[6.4(5.9~6.8)min],[5.2(5.0~5.4)min],(P<0.05),and the K time in the mild,moderate and severe SAHS group were shortened compared with those in the non-OSAHS group[(1.7±0.40)min vs(1.6±0.30)min vs(1.6±0.20)min vs(2.1±0.30)min,(P<0.001),αwas bigger[(68.3±4.20)vs(68.1±3.50)vs(66.4±3.7)vs(60.5±4.20)°,(P<0.001)],and the MA in the middle and severe OSAHS group increased compared with those in the non-OSAHS group[(61.2±2.60)mm,(60.2±3.00)mm vs(57.4±2.40)mm](P<0.01),and the Spearman correlation analysis of TEG indicators showed that①R time was negatively correlated with AHI,AHTI,TS90%,ODI,②K time was negatively correlated with AHI,AHTI,TS90%,③alpha angle was positively correlated with age,waistline,total cholesterol,very low density lipoprotein④MA was positively correlated with BMI,neck circumference,waistline and TS90%.Conclusion The TEG indicator of OSAHS patients has a correlation with OSAHS disease indicator,which can provide basis for evaluating the hypercoagulative state,and it has a certain application value.