体质指数、估算肾小球滤过率在肥厚型心肌病并发阻塞性睡眠呼吸暂停低通气综合征患者中的临床意义

Clinical Significance of BMI and eGFR in Hypertrophic Cardiomyopathy Complicated with Obstructive Sleep Apnea Hypopnea Syndrome Patients

背景阻塞性睡眠呼吸暂停低通气综合征(OSAHS)是指机体在睡眠期间因呼吸气流减少而导致的睡眠障碍,其是肥厚型心肌病(HCM)患者常见并发症,可导致患者交感神经过度激活,影响迷走神经活性,进而损伤血管舒张功能,形成恶性循环。因此,寻找一种指标来预测HCM并发OSAHS高风险人群至关重要。目的探讨体质指数(BMI)、估算肾小球滤过率(eGFR)在HCM并发OSAHS患者中的临床意义。方法选取2018—2020年武汉市第七医院收治的HCM合并OSAHS患者70例为研究组,另选取本院同期收治的单纯HCM患者140例为对照组。比较两组患者的临床资料,采用多因素Logistic回归分析探讨HCM患者并发OSAHS的影响因素,绘制受试者工作特征(ROC)曲线以评估年龄、BMI、eGFR对HCM患者并发OSAHS的预测价值。结果研究组患者年龄大于对照组,BMI、收缩压及血肌酐(Scr)水平高于对照组,eGFR、左心室质量指数低于对照组(P<0.05)。多因素Logistic回归分析结果显示,年龄〔OR=1.425,95%CI(1.131,1.795)〕、BMI〔OR=1.956,95%CI(1.369,2.795)〕、eGFR〔OR=0.663,95%CI(0.523,0.840)〕是HCM患者并发OSAHS的独立影响因素(P<0.05)。ROC曲线分析结果显示,BMI、eGFR预测HCM患者并发OSAHS的曲线下面积(AUC)分别为0.712〔95%CI(0.672,0.833)〕、0.789〔95%CI(0.702,0.887)〕,而年龄相应的AUC仅为0.543。结论HCM并发OSAHS患者BMI较高,而eGFR较低。BMI、eGFR是HCM患者并发OSAHS的独立影响因素,且二者对HCM并发OSAHS均具有一定预测价值。

Background Obstructive sleep apnea hypopnea syndrome(OSAHS)is a sleep disorder caused by the decrease of respiratory airflow during sleep,which is a common complication of hypertrophic cardiomyopathy(HCM),can lead to excessive activation of sympathetic nerve,affect the activity of vagus nerve,damage vasodilation function,and then form a vicious circle.Therefore,it is very important to find predictors to identify the high risk of OSAHS in HCM patients.Objective To investigate the clinical significance of BMI and eGFR in HCM complicated with OSAHS patients.Methods A total of 70 patients with HCM complicated with OSAHS treated in Wuhan NO.7 Hospital from 2018 to 2020 were selected as the study group,and 140 patients with simple HCM during the same period in our hospital were selected as the control group.Clinical data were compared between the two groups.Multivariate Logistic regression analysis was used to explore the influencing factors of OSAHS in patients with HCM,and receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of age,BMI,eGFR on OSAHS in patients with HCM.Results Age in the study group was larger than that in the control group,BMI,blood systolic pressure and serum creatinine(Scr)level were higher than those in the control group,eGFR,left ventricular mass index were lower than those in the control group(P<0.05).Multivariate Logistic regression analysis showed that,age[OR=1.425,95%CI(1.131,1.795)],BMI[OR=1.956,95%CI(1.369,2.795)],eGFR[OR=0.663,95%CI(0.523,0.840)]were independent influencing factors of OSAHS in patients with HCM(P<0.05).ROC curve showed that,area under curve(AUC)of BMI,eGFR in predicting OSAHS in patients with HCM was 0.712[95%CI(0.672,0.833)],0.789[95%CI(0.702,0.887)],respectively,and age related AUC was only 0.543.Conclusion BMI increased and eGFR decreased in patients with HCM complicated with OSAHS,which are independent influencing factors of OSAHS in patients with HCM,and have certain preditive value in HCM patients complicated with OSAHS.