实时三维超声心动图评价阻塞型睡眠呼吸暂停低通气综合征患者连续气道正压通气治疗前后右心室结构及功能变化

Real-time three-dimensional echocardiography evaluation on changes of right ventricular structure and function in patients with obstructive sleep apnea hypopnea syndrome before and after continuous positive airway pressure therapy

目的观察实时三维超声心动图(RT-3DE)评价连续气道正压通气(CPAP)治疗前后阻塞型睡眠呼吸暂停低通气综合征(OSAHS)患者右心室结构及功能变化的价值。方法纳入50例OSAHS患者(OSAHS组)及40名健康志愿者(对照组),比较组间RT-3DE及传统超声心动图参数差异;观察OSAHS组CPAP治疗前及治疗3、6个月后各参数变化。采用组内相关系数(ICC)评价观察者内及观察者间测量结果的一致性,以Pearson相关性检验评估睡眠呼吸暂停低通气指数(AHI)与右心室各参数间相关性;以AHI为因变量、右心室各参数为自变量行多元逐步回归分析。结果OSAHS组右心室舒张末期容积(RVEDV)、右心室收缩末期容积(RVESV)、RVEDV指数(RVEDVI)及RVESV指数(RVESVI)均显著大于对照组(P均<0.05),右心室射血分数(RVEF)、三尖瓣环收缩期位移(TAPSE)及E/A均小于对照组(P均<0.05)。观察者内及观察者间测量结果一致性均良好(ICC均>0.75,P均<0.05)。AHI与RVEF、TAPSE及E/A均呈负相关(r=-0.64、-0.40、-0.45,P均<0.05),与RVEDV、RVESV、RVEDVI及RVESVI均呈正相关(r=0.52、0.61、0.58、0.65,P均<0.05)。RVESV、RVESVI及RVEF可作为AHI的独立预测因子(P均<0.05)。治疗3个月后RVEDV、RVESV、RVESVI及E/A与治疗前差异均有统计学意义(P均<0.05),治疗6个月后各RT-3DE参数与治疗3个月比较差异均有统计学意义(P均<0.05)。结论OSAHS患者存在右心室结构及功能异常;RT-3DE评估CPAP治疗后右心室功能改善的效果优于传统超声心动图参数。

Objective To observe the value of real-time three-dimensional echocardiography(RT-3DE)for evaluating changes of right ventricular structure and function before and after continuous positive airway pressure(CPAP)therapy in patients with obstructive sleep apnea hypopnea syndrome(OSAHS).Methods Fifty OSAHS patients(OSAHS group)and 40 healthy volunteers(control group)were enrolled.RT-3DE and conventional echocardiography parameters were compared between groups.The improvements of parameters in OSAHS group were evaluated before and 3,6 months after CPAP therapy.The consistency of intra-observer and inter-observer measurements was explored with intra-class correlation coefficient(ICC).Pearson correlation test was used to evaluate the correlation of sleep apnea hypopnea index(AHI)and right ventricular parameters.Taken AHI as dependent variable and right ventricular parameters as independent variables,multiple stepwise regression analysis was performed.Results The right ventricular end-diastolic volume(RVEDV),right ventricular end-systolic volume(RVESV),RVEDV index(RVEDVI)and RVESV index(RVESVI)in OSAHS group were significantly higher than those in control group(all P<0.05),while the right ventricular ejection fraction(RVEF),tricuspid annular plane systolic excursion(TAPSE)and E/A were lower than those in control group(all P<0.05).The consistency of intra-observer and inter-observer measurements was good(all ICC>0.75,all P<0.05).AHI was negatively correlated with RVEF,TAPSE and E/A(r=-0.64,-0.40,-0.45,all P<0.05),but positively correlated with RVEDV,RVESV,RVEDVI and RVESVI(r=0.52,0.61,0.58,0.65,all P<0.05).RVESV,RVESVI and RVEF were independent predictors of AHI(all P<0.05).There were statistically significant differences of RVEDV,RVESV,RVESVI and E/A between 3 months after therapy and before therapy(all P<0.05),also of RT-3DE parameters between 3 and 6 months after therapy(all P<0.05).Conclusion OSAHS caused changes of right ventricular structure and function.Compared with conventional echocardiography parameters,RT-3DE was more effective for evaluation on the improvement of right ventricular structure and function in OSAHS patients after CPAP therapy.