急性脑梗死合并阻塞性睡眠呼吸暂停综合征患者的危险因素分析

Clinical analysis of risk factors of acute cerebral infarction patients with obstructive sleep apnea syndrome

目的 探讨合并阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)综合征的急性脑梗死(acute cerebral infarction,ACI)患者的危险因素并进行分析.方法 选择ACI患者96例,脑梗死发病后7 d内完善头颅磁共振血管成像(MRA)检查及颈动脉彩色超声检查了解颅内外动脉病变情况;第(8±2)天完善多导睡眠图(PSG)和抽血等生化指标检查,根据睡眠呼吸暂停低通气指数(apnea hypopnea index,A HI)分成ACI不伴OSA(acute cerebral infarction-not obstructive sleep apnea,ACI-NOSA)组 、ACI伴OSA(acute cere-bral infarction-obstructive sleep apnea,ACI-OSA)组,后者分为轻(ACI-LOSA)、中(ACI-M OSA)、重(ACI-HOSA)3组.结果 96例ACI患者中,68.75%(66/96)合并OSA,其中ACI-LOSA 18例,ACI-M OSA 35例,ACI-HOSA 13例.ACI-OSA组高血压发生率(71.21%)、同型半胱氨酸(Hcy)水平[(21.70±17.36)μmol/L]均高于ACI-NOSA组[46.67% 、(12.49±8.90)μmol/L](P<0.05),2组间体重指数(BMI)、血糖 、纤维蛋白原(FIB)、血脂比较差异无统计学意义(P>0.05).颅内动脉狭窄在ACI-OSA患者中占61.29%,在ACI-NOSA患者中占14.29%;颈动脉粥样硬化在ACI-OSA患者中占67.74%,在ACI-NOSA患者中占35.71%.结论 脑梗死患者合并OSA时高血压发病率及Hcy水平明显升高;OSA增加颅内外动脉粥样硬化风险,且OSA程度越重,动脉硬化的程度越重.

Objective To Investigate the risk factors of acute cerebral infarction(ACI)with obstructive sleep apnea(OSA)syndrome.Methods 96 ACI patients,detected by cranial magnetic resonance angiography and color ultrasound examination of the carotid artery within 7 days of onset and by polysomnography(PSG)within(8±2)days and extracted blood,and were classified by apnea hypopnea index(AHI)into two groups:acute cerebral infarction not obstructive sleep apnea(ACI NOSA)group(AHI<5)and acute cerebral infarction obstructive sleep apnea(ACI OSA)(AHI≥5).ACI OSA group was divided into three groups.Results The prevalence of OSA in 96 ACI patients was 68.75%(66/96),ACI Light OSA(n=18),ACI Middle OSA(n=35),ACI Heavy OSA(n=13).The prevalence(71.21%)of hypertension and the level((21.70±17.36)μmol/L)of Hcy were higher in ACI OSA group than ACI NOSA group(46.67%,(12.49±8.90)μmol/L)(P<0.05).There were no statistical differences in body mass indicts(BMI),blood glucose,fibrinogen,blood lipids between two groups(P>0.05).The prevalence of intracranial arterial stenosis was 61.29%in ACI OSA group,14.29%in ACI NOSA;the prevalence of carotid atherosclerosis was 67.74%in ACI OSA group,35.71%in ACI NOSA group.Conclusion The prevalence of hypertension and the level of Hcy were higher in ACI OSA patients.OSA increased the risk of intracranial and extracranial atherosclerosis;the more severe OSA was,the more severe atherosclerosis was.