阻塞性睡眠呼吸暂停对肺血栓栓塞症患者疾病严重程度及预后的影响研究

Effects of obstructive sleep apnea on severity and prognosis of patients with pulmonary thromboembolism

目的探讨阻塞性睡眠呼吸暂停(OSA)对肺血栓栓塞症(PTE)患者疾病严重程度及预后的影响。方法选取2015年6月至2016年12月于该院住院的PTE合并OSA患者共72例,依据睡眠呼吸暂停低通气指数(AHI)分为AHI≤15次/h组(轻度组)和AHI>15次/h组(中重度组),比较两组患者临床指标及辅助检查指标,应用logistic回归模型分析肺栓塞严重指数(sPESI)与各临床指标及辅助检查指标的相关性;所有患者进行5年随访,随访结束时,依据患者是否出现PTE的复发,分为复发组和未复发组,比较两组患者D-二聚体(D-dimer)水平、AHI、平均指脉氧饱和度(MSpO_(2))、体重指数(BMI)、sPESI评分,应用logistic回归模型分析PTE复发与各临床指标的相关性。结果与轻度组比较,中重度组患者年龄大,合并慢性心肺疾病比例、sPESI≥1分比例、D-dimer及B型尿钠肽(NT-proBNP)水平增高(P<0.05),而MSpO_(2)、最低指脉氧饱和度(LSpO_(2))、氧分压(PaO_(2))水平均降低(P<0.05)。OSA合并PTE患者中,AHI是sPESI≥1分风险度增加的独立危险因素。13例患者出现PTE复发,与未复发组比较,复发组患者D-dimer水平、AHI>15次/h比例升高(P<0.05),而MSpO_(2)降低(P<0.05)。OSA合并PTE患者中,AHI是PTE复发风险度增加的独立危险因素。结论合并中重度OSA的PTE患者病情可能更严重,易复发。

Objective To investigate the effects of obstructive sleep apnea(OSA)on severity and prognosis of patients with pulmonary thromboembolism(PTE).Methods A total of 72 patients with PTE complicated with OSA who were hospitalized in this hospital from June 2015 to December 2016 were selected and divided into the apnea-hypopnea index(AHI)≤15 times/h group(the mild group)and the AHI>15 times/h group(the moderate to severe group)according to the AHI value.The clinical indexes and auxiliary examination indexes of the two groups were compared,and the correlations between the simplified pulmonary embolism severity index(sPESI)and various clinical indexes and auxiliary examination indexes were analyzed by logistic regression model.All the patients were followed up for five years.At the end of the follow-up,they were divided into the recurrence group and the non-recurrence group according to whether there was recurrence of PTE.The D-dimer level,AHI,mean pulse oxygen saturation(MSpO_(2)),body mass index(BMI),and sPESI score of the two groups were compared.Logistic regression model was used to analyze the correlation between PTE recurrence and various clinical indexes.Results Compared with patients in the mild group,patients in the moderate to severe group were older,with the proportion of chronic cardiopulmonary diseases,the proportion of sPESI≥1,the levels of D-dimer and N-terminal brain natriuretic peptide(NT-proBNP)significantly increased(P<0.05),while the levels of MSpO_(2),the lowest pulse oxygen saturation(LSpO_(2))and partial pressure of oxygen(PaO_(2))significantly decreased(P<0.05).In patients with OSA complicated with PTE,AHI was an independent risk factor for increasing the risk of sPESI≥1.PTE recurred in 13 patients,and compared with the non-recurrence group,the level of D-dimer and the proportion of AHI>15 times/h in the recurrence group significantly increased(P<0.05),while MSpO_(2)significantly decreased(P<0.05).In patients with OSA complicated with P TE,AHI was an independent risk factor for increasing the recurrence risk of PTE.Conclusion PTE patients with moderate to severe OSA may have more severe condition,and are prone to relapse.