阻塞性睡眠呼吸暂停低通气综合征对缺血性卒中患者血小板功能的影响

Impact of obstructive sleep apnea hypopnea syndrome on platelet function in patients with ischemic stroke

目的探讨阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)对缺血性卒中患者血小板功能的影响。方法前瞻性收集2017年1月至2017年11月威海市立医院神经内科收治的缺血性卒中患者,通过多导睡眠监测判定有无OSAHS。口服阿司匹林肠溶片(7±1)d后,采用PL-12血小板功能分析仪测定花生四烯酸(arachidonic acid,AA)诱导的最大血小板聚集率(maximum aggregation ratio,MAR),MAR-AA≥50%定义为血小板高反应性。应用多变量logistic回归分析评价卒中患者血小板高反应性的危险因素,并使用多元线性回归分析确定反映睡眠呼吸暂停严重程度的睡眠参数与MAR-AA的相关性。结果在124例缺血性卒中患者中,合并OSAHS患者58例(46.77%),未合并OSAHS患者66例(53.23%);存在血小板高反应性84例(67.74%),无血小板高反应性40例(32.26%)。合并OSAHS组MAR-AA显著高于未合并OSAHS组[(48.98±20.61)%对(26.45±15.15)%;t=-6.858,P<0.001]。多变量logistic回归分析显示,OSAHS是引起缺血性卒中患者血小板高反应性的独立危险因素(优势比9.551,95%置信区间3.051~29.905;P<0.001)。多元线性回归分析显示,呼吸暂停低通气指数与MAR-AA存在显著线性关系(β=0.499,P<0.001)。结论OSAHS是导致缺血性卒中患者血小板高反应性的独立危险因素,呼吸暂停低通气指数与MAR-AA存在显著相关性。

Objective To investigate the impact of obstructive sleep apnea hypopnea syndrome(OSAHS)on platelet function in patients with ischemic stroke.Methods Patients with ischemic stroke treated in the Department of Neurology,Weihai Municipal Hospital from January 2017 to November 2017 were collected prospectively.The presence or absence of OSAHS was determined by polysomnography.After oral administration of aspirin enteric coated tablets for 7±1 d,the maximum aggregation ratio(MAR)induced by arachidonic acid(AA)was determined by PL-12 Platelet Function Analyzer.MAR-AA≥50%was defined as platelet hyperresponsiveness.Multivariate logistic regression analysis was used to evaluate the risk factors for platelet hyperresponsiveness in patients with ischemic stroke,and multiple linear regression analysis was used to determine the correlation between sleep parameters reflecting the severity of sleep apnea and MAR-AA.Results Among the 124 patients with ischemic stroke,58(46.77%)complicated with OSAHS,66(53.23%)without complicated with OSAHS;84(67.74%)had platelet hyperresponsiveness,and 40(32.26%)had not platelet hyperresponsiveness.MAR-AA in the complicated OSAHS group was significantly higher than that in the non-complicated OSAHS group(48.98%±20.61%vs.26.45%±15.15%;t=-6.858,P<0.001).Multivariate logistic regression analysis showed that OSAHS was an independent risk factor for platelet hyperresponsiveness in patients with ischemic stroke(odds ratio 9.551,95%confidence interval 3.051-29.905;P<0.001).Multiple linear regression analysis showed that there was a significant linear relationship between apnea hypopnea index and MAR-AA(β=0.499,P<0.001).Conclusions OSAHS is an independent risk factor for platelet hyperresponsiveness in patients with ischemic stroke.Apnea hypopnea index is significantly correlated with MAR-AA.