阻塞性睡眠呼吸暂停综合征对急性心肌梗死患者心肌做功及预后的影响  

Effects of obstructive sleep apnea syndrome on myocardial work and prognosis in patients with acute myocardial infarction

作　　者：项丽[1] 成雅萍 王婧[2] 吴燕妮[1] 陈锐[2] Xiang Li;Cheng Yaping;Wang Jing;Wu Yanni;Chen Rui(Department of Cardiology,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China;Department of Respiratory,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心内科,苏州215004 [2]苏州大学附属第二医院呼吸科,苏州215004

出　　处：《中华医学杂志》2023年第48期3946-3953,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指导性项目(SKYXD2022048)

摘　　要：目的探讨阻塞性睡眠呼吸暂停综合征(OSAS)对急性心肌梗死(AMI)患者的心肌做功(MW)及预后的影响。方法回顾性收集2020年2月至2022年1月因胸痛发作24 h内入住苏州大学附属第二医院且诊断为AMI的有完整随访资料的210例患者,男130例,女80例;年龄36~83(69.6±9.4)岁。依据睡眠呼吸暂停低通气指数(AHI)将患者分为OSAS组(AHI≥5次/h)和非OSAS组(AHI<5次/h)。随访(12.4±0.1)个月。对比两组一般临床资料、血液学检查指标、超声心动图参数、MW以及1年主要心脏不良事件(MACE)的发生情况。以logistic回归模型分析和受试者工作特征(ROC)曲线评估AMI患者发生MACE的风险。结果OSAS组50例,非OSAS组160例。OSAS组高血压病史、高血脂病史、吸烟史的比例,体质指数(BMI)、颈围、Killip分级、全球急性冠状动脉事件注册研究(GRACE)评分、Epworth嗜睡量表(ESS)评分、总病变支数,以及SYNTAX评分均高于非OSAS组(均P<0.05)。两组睡眠检测数据和血液学检测指标的差异均有统计学意义(均P<0.05)。OSAS组整体做功指数(GWI)低于非OSAS组[(870.1±435.6)比(1005.0±313.6)mmHg%(1 mmHg=0.133 kPa),P=0.017],心肌整体有用功(GCW)低于非OSAS组[(1046.7±472.2)比(1262.7±274.9)mmHg%,P=0.003],整体做功效率(GWE)低于非OSAS组[(79.8±14.2)%比(84.5±5.8)%,P=0.001],整体无用功(GWW)高于非OSAS组[(312.2±163.2)比(264.0±85.1)mmHg%,P=0.007]。OSAS组发生MACE 10例(20.0%),非OSAS组发生13例(8.1%),差异有统计学意义(P=0.001)。合并OSAS(OR=4.039,95%CI:1.159~6.918),心肌做功下降包括GCW(OR=0.850,95%CI:0.742~0.958)、GWE(OR=0.871,95%CI:0.818~0.924)、GWI(OR=0.862,95%CI:0.732~0.991),GWW(OR=2.425,95%CI:1.482~3.368)及GRACE评分升高(OR=3.775,95%CI:2.314~5.236)增加了AMI患者发生MACE的风险(均P<0.05)。OSAS+MW+GRACE评分预测AMI发生MACE的ROC曲线下面积(AUC)为0.779(95%CI:0.717~0.834),灵敏度为65.2%,特异度为84.5%;三者联合后与OSAS、GRACE评分、心肌做功的AUC差异�Objective To investigate the influence of obstructive sleep apnea syndrome(OSAS)on myocardial work and prognosis in patients with acute myocardial infarction(AMI).Methods Patients with complete follow-up data diagnosed with AMI who were admitted to the Second Affiliated Hospital of Suzhou University due to chest pain within 24 hours attacks from February 2020 to January 2022 were retrospective enrolled in the study and were split into two groups based on sleep apnea hypoventilation index(AHI):OSAS group(AHI≥5/h)and non-OSAS group(AHI<5/h).Follow up for(12.4±0.1)months.There were finally 210 AMI patients including 130 males and 80 females with(69.6±9.4)years,ranging from 36 to 83 years.The general characteristics,haematological index,echocardiographic parameters,myocardial work(MW)and the occurrence of major adverse cardiac events(MACE)in 1 year between the two groups were quantified.Logistic regression analysis and receiver operating characteristic(ROC)curve were used to assess the risk of MACE in patients with AMI.Results There were 50 cases in the OSAS group and 160 cases in the non-OSAS group.Compared with the non-OSAS group,OSAS group demonstrated higher BMI,neck circumference,Killip grade,GRACE score,ESS score,SYNTAX score,the number of diseased vessels and higher prevalence of hypertension,hyperlipidemia and smoking history.The differences were statistically significant(P<0.05).There were also statistically significant differences in sleep study result and hematological indexesof of cTnT,NT-ProBNP,and creatinine between the two groups(P<0.05).The general work index(GWI)of the OSAS group was lower than that of the non-OSAS group[(870.1±435.6)vs(1005.0±313.6)mmHg%(1 mmHg=0.133 kPa),P=0.017];The general myocardial active work(GCW)of the OSAS group was lower than that of the non-OSAS group[(1046.7±472.2)vs(1262.7±274.9)mmHg%,P=0.003];The general work efficiency(GWE)of the OSAS group was lower than that of the non-OSAS group[(79.8±14.2)%vs(84.5±5.8)%,P=0.001];The general reactive power(GWW)of the OSAS

关 键 词：睡眠呼吸暂停 阻塞性 急性心肌梗死 心肌做功 主要心脏不良事件 回顾性队列研究 

分 类 号：R766[医药卫生—耳鼻咽喉科] R542.22[医药卫生—临床医学]