CT测量主肺动脉直径在阻塞性睡眠呼吸暂停低通气综合征患者中的临床研究

Clinical study of main pulmonary artery diameter measured by CT in obstructive sleep apnea hypopnea syndrome patients

目的研究探索主肺动脉直径(main pulmonary artery diameter,dPA)及主肺动脉与升主动脉直径的比值(the ratio of main pulmonary artery to aortic diameter,rPA)在阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患者中的变化以及研究心脏彩超未提示肺动脉高压的OSAHS患者dPA及rPA改变与睡眠呼吸暂停低通气指数(apnea hypopnea index,AHI)及夜间最低血氧饱和度(SpO_(2))的内在联系。方法回顾性分析2019年至2021年复旦大学附属中山医院呼吸睡眠中心接受睡眠呼吸监测的146例患者,入组研究对象均进行过胸部CT检查及心脏彩超检查,根据睡眠呼吸监测中AHI及最低SpO_(2)进行分组,在胸部CT下测量dPA、计算rPA,整理各组数据并进行统计学分析。结果重度OSAHS患者组dPA为(2.82±0.33)cm,较单纯鼾症组的dPA(2.59±0.38)cm增宽;重度SpO_(2)减低组dPA为(2.73±0.34)cm,轻度SpO_(2)减低组dPA为(2.75±0.35)cm,均较正常SpO_(2)组的dPA(2.53±0.37)cm增宽,同时AHI与dPA有一定的正相关性。结论OSAHS患者在疾病初期心脏彩超未能提示肺动脉高压时,CT测量dPA显示,OSAHS患者肺动脉增宽,且与AHI呈正相关,肺动脉宽度可能对OSAHS患者的早期肺动脉高压识别及肺动脉压力评估有一定的临床意义。

Objective To explore changes of the main pulmonary artery diameter(dPA)and the ratio of main pulmonary artery to ascending aorta diameter(rPA)in patients with obstructive sleep apnea hypopnea syndrome(OSAHS),and to investigate the relationship between the changes of dPA and rPA with the apnea hypopnea index(AHI)and nocturnal minimum oxygen saturation(SpO_(2))in OSAHS patients without pulmonary hypertension by echocardiography.Methods A total of 146 patients with sleep respiration monitored in the Respiratory and Sleep Center of Zhongshan Hospital affiliated to Fudan University from 2019 to 2021 were retrospectively analyzed.All subjects underwent chest CT examination and heart ultrasound examination.According to the sleep apnea monitoring of sleep AHI and the lowest SpO_(2) group,dPA was measured and rPA was calculated under chest CT.The data of each group was collected and statistically analyzed.Results The dPA of patients with severe OSAHS was(2.82±0.33)cm,which was wider than that of patients with simple snoring(2.59±0.38)cm.The dPA of the severe SpO_(2) reduction group was(2.73±0.34)cm,and that of the mild SpO_(2) reduction group was(2.75±0.35)cm,which was wider than that of the normal SpO_(2) group(2.53±0.37)cm.At the same time,there was a positive correlation between AHI and dPA.Conclusion When pulmonary hypertension failed to detect by color doppler echocardiography in patients with OSAHS at the early stage of the disease,dPA measured by CT showed pulmonary artery widening in patients with OSAHS,which was positively correlated with AHI.Pulmonary artery width may have certain clinical significance for the early recognition of pulmonary hypertension and assessment of pulmonary artery pressure in patients with OSAHS.