阻塞性睡眠呼吸暂停对急性冠脉综合征严重程度的影响  

Effect of obstructive sleep apnea on the severity of acute coronary syndrome

作　　者：成雅萍 王智君 项丽[2] 王欣然 苏桐 陈锐[1] Cheng Yaping;Wang Zhijun;Xiang Li;Wang Xinran;Su Tong;Chen Rui(Department of Respiratory,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China;Department of Cardiology,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China)

机构地区：[1]苏州大学附属第二医院呼吸科,苏州215004 [2]苏州大学附属第二医院心内科,苏州215004

出　　处：《中华医学杂志》2024年第27期2541-2548,共8页National Medical Journal of China

基　　金：国家自然科学基金(81770085、82070095);苏州市科技发展计划(SKY2023054)

摘　　要：目的探讨阻塞性睡眠呼吸暂停(OSA)对急性冠脉综合征(ACS)患者心肌损伤、冠脉多支病变及其术后指标的影响。方法前瞻性收集苏州大学附属第二医院2022年9月至2023年10月因胸闷胸痛入院、诊断ACS并行急诊/择期经皮冠状动脉介入治疗(PCI)的患者,待病情稳定后[术后(2±1)d]行便携式睡眠呼吸监测仪检查。根据睡眠呼吸暂停低通气指数(AHI)将患者分为OSA组(AHI≥15次/h)和对照组(AHI<15次/h),比较两组患者血液学指标、超声心电图参数、冠脉血管评分以及术后指标等差异;采用二元logistic回归模型分析ACS患者发生冠脉多支病变的危险因素。结果最终纳入符合入排标准的104例ACS患者,男85例(81.7%),女19例(18.3%),年龄(57.3±10.8)岁,其中48.1%(50/104)合并OSA。OSA组患者体质指数(BMI)、高血压及糖尿病患病率、甘油三酯(TG)、糖化血红蛋白(HbA1c)以及D-二聚体均高于对照组(均P<0.05);两组患者睡眠参数的差异均有统计学意义(均P<0.05);OSA组患者肌钙蛋白T(cTnT)更高[M(Q_(1),Q_(3)),54.0(9.3,343.8)ng/L比15.0(7.8,38.8)ng/L,P<0.05],左房内径更大[41.4(39.3,45.2)mm比40.2(37.1,42.0)mm,P<0.05],病变血管数更多[2(1,3)支比1(1,2)支,P<0.001],多支病变为主[60.0%(30/50)比29.6%(16/54),P<0.05],住院期间心血管并发症的发生率也更高[10.0%(5/50)比0(0/54),P=0.017]。二元logistic回归分析结果提示,调整相关混杂因素后,只有AHI(OR=1.035,95%CI:1.008~1.063,P=0.011)与ACS患者发生冠脉多支病变相关。结论合并OSA的ACS患者心肌损害更重,更易出现左心结构改变,更易发生冠脉多支病变,且术后并发症发生率高;高AHI是ACS患者发生冠脉多支病变的危险因素。Objective To investigate the effects of obstructive sleep apnea(OSA)on myocardial damage,coronary multi-vessel lesion and postoperative indexes in patients with acute coronary syndrome(ACS).Methods The patients,admitted to the Second Affiliated Hospital of Soochow University from September 2022 to October 2023 due to chest tightness and pain,diagnosed with ACS and accompanied by emergency/elective percutaneous coronary intervention(PCI)at,were prospectively enrolled.Portable sleep monitor was used to monitor after stabilization of condition(postoperative day 2±1).The patients were divided into the OSA group(AHI≥15/h)and the control group(AHI<15/h)according to apnea-hypopnea index(AHI).The hematologic indices,echocardiographic parameters,coronary vascular scores and postoperative indicators between the groups were compared.Binary logistic regression model was used to analyze the risk factors for muti-vessel lesion in patients with ACS.Results One hundred and four ACS patients who met the inclusion criteria were ultimately included,including 85 males(81.7%)and 19 females(18.3%),aged(57.3±10.8)years,of whom 48.1%(50/104)were complicated with OSA.Body mass index(BMI),prevalence of hypertension and diabetes,triglyceride(TG),glycosylated hemoglobin A1c(HbA1c)and D-dimer in the OSA group were higher than those in the control group(P<0.05).There were statistically significant differences in sleep parameters between the two groups(P<0.05).The patients in the OSA group exhibited higher troponin T(cTnT)[M(Q_(1),Q_(3)),54.0(9.3,343.8)ng/L vs 15.0(7.8,38.8)ng/L,P<0.05],larger left atrial internal diameters[41.4(39.3,45.2)mm vs 40.2(37.1,42.0)mm,P<0.05],more diseased vessels[2(1,3)vs 1(1,2),P<0.001],a higher percentage of muti-vessel lesion[60.0%(30/50)vs 29.6%(16/54),P<0.05],and a higher incidence of cardiovascular complications during hospitalization[10.0%(5/50)vs 0(0/54),P=0.017].The results of binary logistic regression analysis suggested that after adjusting for confounders,AHI(OR=1.035,95%CI:1.008-1.063,P=0.011)was i

关 键 词：睡眠呼吸暂停 阻塞性 急性冠脉综合征 冠脉多支病变 横断面研究 

分 类 号：R766[医药卫生—耳鼻咽喉科] R541.4[医药卫生—临床医学]