上海地区支气管哮喘合并睡眠呼吸暂停综合征患者FeNO、CRP和PCT水平变化及危险因素分析

Changes of FeNO,CRP and PCT levels in patients with bronchial asthma complicated with sleep apnea syndrome in Shanghai

目的分析上海地区支气管哮喘合并睡眠呼吸暂停综合征(sleep apnea syndrome,SAS)患者FeNO、CRP和PCT水平变化及危险因素,为支气管哮喘患者防治SAS提供理论依据。方法选取2019年1月至2022年6月上海中医药大学附属第七人民医院收治的支气管哮喘患者436例,根据住院期间是否发生SAS分为对照组和实验组,实验组根据呼吸暂停低通气指数(AHI)值分为三个亚组—轻度组(AHI为5~15次/h)、中度组(AHI>15次/h或<30次/h)和重度组(AHI≥30次/h),对比两组血清FeNO、CRP和PCT水平,从病历系统收集患者临床资料,采用单因素分析和logistic回归分析影响支气管哮喘患者发生SAS的影响因素。结果436例支气管哮喘患者中发生SAS 158例(36.24%),其中轻度76例,中度54例和重度28例;实验组血清FeNO、CRP、PCT和AHI水平明显高于对照组(P<0.05);重度组血清FeNO、CRP、PCT和AHI水平明显高于轻度组(t值=5.830,7.597,7.885,40.684,P<0.05);重度组血清FeNO、CRP、PCT和AHI水平明显高于中度组(t值=2.895,3.455,3.001,18.841,P<0.05);中度组血清FeNO、CRP、PCT和AHI水平明显高于轻度(t值=2.924,4.157,6.201,23.640,P<0.05);BMI>28kg/m2(OR=5.629)、合并过敏性鼻炎(OR=6.166)和颈围>40 cm(OR=5.265)是支气管哮喘患者发生SAS的独立危险因素(P<0.05);Pearson相关性分析显示支气管哮喘合并SAS患者AHI值与血清FeNO、CRP和PCT水平呈正相关(r=0.471、0.436、0.502,P<0.05)。结论上海地区老支气管哮喘患者发生SAS的风险较大,其病情严重程度与FeNO、CRP和PCT水平呈正相关,特别是肥胖、合并过敏性鼻炎患者应给予早期干预,可降低发生SAS的风险。

Objective The changes and risk factors of FeNO,CRP and PCT in patients with bronchial asthma complicated with sleep apnea syndrome(SAS)in Shanghai area were analyzed to provide theoretical basis for the prevention and treatment of SAS in patients with bronchial asthma.Methods A total of 436 patients with bronchial asthma admitted to our hospital from January 2019 to June 2022 were selected and divided into control group and experimental group according to whether SAS occurred during hospitalization.The experimental group was divided into three subgroups according to the apnea hypopnea index(AHI)values:mild group(AHI>15 times/h or<30 times/h),moderate group(AHI>15 times/h or<30 times/h)and severe group(AHI≥30 times/h).The serum FeNO,CRP and PCT levels were compared between the two groups.Clinical data of patients were collected from the medical record system.Univariate analysis and logistic regression were used to analyze the factors affecting the occurrence of SAS in patients with bronchial asthma.Results Among the 436 patients with bronchial asthma,158(36.24%)had SAS,including 76 mild,54 moderate and 28 severe;The levels of serum FeNO,CRP,PCT and AHI in the experimental group were significantly higher than those in the control group(P<0.05).Serum FeNO,CRP,PCT and AHI levels in severe group were significantly higher than those in mild group(t=5.830,7.597,7.885,40.684,P<0.05).Serum FeNO,CRP,PCT and AHI levels in severe group were significantly higher than those in moderate group(t=2.895,3.455,3.001,18.841,P<0.05).The levels of serum FeNO,CRP,PCT and AHI in the moderate group were significantly higher than those in the mild group(t=2.924,4.157,6.201,23.640,P<0.05).BMI>28 kg/m2(OR=5.629),allergic rhinitis(OR=6.166)and neck circumference>40 cm(OR=5.265)were independent risk factors for SAS in patients with bronchial asthma(P<0.05);Pearson correlation analysis showed that AHI was positively correlated with serum FeNO,CRP and PCT levels in patients with bronchial asthma and SAS(r=0.471,0.436,0.502,P<0.05).Conclusions Patients with old bronchial asthma in Shanghai area have a higher risk of SAS,and the severity of the disease is positively correlated with the levels of FeNO,CRP and PCT.In particular,obese patients with allergic rhinitis should be given early intervention to reduce the risk of SAS.