日间氧分压在阻塞性OSAHS慢性阻塞性肺疾病及重叠综合征的变化

目的分析阻塞性睡眠呼吸暂停低通气综合征(OSAHS)、慢性阻塞性肺疾病(COPD)及重叠综合征(OS)患者日间及夜间PaO2的变化,探讨夜间氧合血红蛋白去饱和与日间PaO2的关系.方法对呼吸内科就诊的患者进行筛选分析,并进行肺功能检测和动脉血气分析等相关检查,筛选出720例患者.根据肺功能结果其分为3组:OSAHS(n=466);OS(n=168)和COPD(n=86).另选择520例体检健康者为对照,采用ANOVA分析评估四组间的差异,并通过多元线性回归分析日间PaO2差异的因素.结果与OSAHS患者相比,OS组显示出较低的日间PaO2水平,和较高的血氧饱和度<90%占整个睡眠时间的百分比(T90).多元线性回归分析显示,OS日间PaO2与年龄(β=0.20)相关,且与FEV1(β=0.31)和T90(β=0.37)相关.而在OSAHS中,与FEV1(β=0.11)、BMI(β=0.25)、年龄和T90均相关.结论日间PaO2的变化是多种因素(BMI,T90,FEV1等)互相作用的结果,但T90所代表的夜间氧合血红蛋白去饱和更为明显,特别是在OS患者中,夜间低通气对于日间PaO2的影响更为明显.

Objective OSAHS and COPD are often associated with day-time hypoxemia.Overlap Syndrome(OS),the association between both diseases,increases the risk of day-time hypoxemia.To investigate the mechanisms which can justify the low oxygen level.Methods The patients referred to our respiratory department were screened and analyzed and who also underwent relevant laboratory test such as spirometry and blood gas analysis.According to pulmonary flinction test and polysomno graph parameters,they were divided into 3 groups:OSAHS(n=466);OS(n=168)and COPD(n=86).In order to evaluate the differences between the three groups,ANOVA analysis were carried out,whereas a multivariate analysis was performed in order to evaluate which factors determine the diurnal Pa02.Results The OS group showed a lower level of daytime Pa02 compared with OSAHS patients and T90 was higher in OS compared with OSAHS.A multivariate analysis showed that in the OS diurnal Pa02 correlated with age((β=0.20)and moreover with FEV,(β=0.31)and T90(β=0.37),while in the OSAHS a correlation was found with FEV1(β=0.11)and mostly with BMI(β=0.25),age and T90.Conclusion Our results mean that diurnal Pa02 is the result of a mix of factors(BMI,T90,FEV1),blit the nocturnal oxyhemoglobin desatiiration represented by T90 is more obvious,especially among OS patients.In OS patients,nocturnal hypoventilation has a more pronounced effect on daytime Pa02.