中性粒细胞/淋巴细胞比值评估B型主动脉夹层合并阻塞性睡眠呼吸暂停的临床价值

Clinical Value of Neutrophil to Lymphocyte Ratio in Type B Aortic Dissection Complicated with Obstructive Sleep Apnea

目的:探究中性粒细胞/淋巴细胞比值(NLR)评估B型主动脉夹层(TBAD)并发阻塞性睡眠呼吸暂停(OSA)的临床价值。方法:选取2017年1月至2021年7月在厦门大学附属第一医院心脏外科住院治疗的TBAD患者188例作为研究对象,根据多导睡眠监测(PSG)的结果分为观察组(n=109)和对照组(n=79),收集2组患者基线人口学资料、入院首次抽血指标、STOP-Bang评分及PSG参数,用多因素Logistic回归分析TBAD合并OSA的独立危险因素,绘制NLR和STOP-Bang评分预测OSA受试者的工作特征(ROC)曲线,采用斯皮尔曼(Spearman)相关分析评估NLR与呼吸暂停低通气指数(AHI)的相关性。结果:58%TBAD患者合并OSA,其中95.4%合并中重度OSA,观察组NLR、STOP-Bang评分显著高于对照组(P<0.05),多因素Logistic回归分析发现,STOP-Bang评分及NLR预测OSA的独立危险因素(P<0.05),NLR预测OSA的ROC曲线下面积(AUC)显著大于STOP-Bang评分(P<0.05),诊断OSA的灵敏度及特异度也显著高于STOP-Bang评分(P<0.05),Spearman相关分析提示NLR与AHI正相关(P<0.05)。结论:对于TBAD患者,NLR对OSA的诊断效能高于STOP-Bang评分,且与OSA严重程度正相关。NLR对TBAD合并OSA的诊断及严重度评估有较高的临床价值。

Objective:To investigate the clinical value of neutrophil to lymphocyte ratio(NLR)in patients with type B aortic dissection(TBAD)complicated with obstructive sleep apnea(OSA).Methods:A total of 188 TBAD patients hospitalized in the Department of Cardiac Surgery of the First Affiliated Hospital of Xiamen University from January 2017 to July 2021 were selected.They were divided into OSA group(n=109)and control group(n=79)according to polysomnography(PSG)results.Baseline demographic data,first blood parameters,STOP-Bang scores and PSG parameters of the two groups were collected.Multivariate Logistic regression was used to analyze the independent risk factors of OSA,and receiver operating characteristic(ROC)curves of NLR and STOP-BANG scores for predicting OSA were drawn.Spearman correlation analysis was used to evaluate the correlation between NLR and apnea and hypopnea index(AHI).Results:Fifty-eight percent of TBAD patients had OSA,of which 95.4%had moderate to severe OSA.NLR and STOP-Bang scores in OSA group were significantly higher than those in control group(P<0.05),multivariate Logistic regression analysis showed that STOP-Bang score and NLR were independent risk factors for OSA.The area under ROC curve(AUC)of OSA predicted by NLR was significantly larger than that of STOP-Bang scores(P<0.05),and the sensitivity and specificity of OSA diagnosis were significantly higher than those of STOP-Bang scores.Spearman correlation analysis showed that NLR was positively correlated with AHI(P<0.05).Conclusion:In TBAD patients,NLR can better predict OSA,and its diagnostic efficiency was higher than STOP-Bang scores.NLR has excellent value in the diagnosis and severity evaluation of OSA in TBAD patients.