阻塞性睡眠呼吸暂停低通气综合征及其合并冠心病患者血清胆红素水平的变化及临床意义  

Changes and Clinical Significance of Serum Bilirubin Levels in Patients with OSAHS and OSAHS Combined with CHD

作　　者：杨运凤[1] 韦凡平[1] 张川[1] 袁高辉[1] 程震峰[1] 

机构地区：[1]浙江省湖州市中心医院心血管内科,313000

出　　处：《中国全科医学》2013年第6期608-611,共4页Chinese General Practice

摘　　要：目的检测单纯阻塞性睡眠呼吸暂停低通气综合征(OSAHS)及其合并冠心病(CHD)患者血清胆红素水平的变化,探讨OSAHS患者的病理生理变化及OSAHS合并CHD的发病机制。方法从2011年我院心血管内科及呼吸内科就诊的患者中随机选取OSAHS患者90例,其中单纯OSAHS患者45例,OSAHS合并CHD患者45例;另选取同期体检健康者24例为正常对照组。比较3组间临床资料及血清胆红素水平,统计分析血清胆红素水平与患者睡眠呼吸检测指标及CHD临床资料间的相关性。结果 3组血清总胆红素(TBIL)及间接胆红素(IBIL)水平比较,差异均有统计学意义(P<0.05),组间两两比较差异亦均有统计学意义(P<0.05);3组直接胆红素(DBIL)水平比较,差异无统计学意义(P>0.05)。血清TBIL水平与DBIL水平及IBIL水平呈正相关(r值分别为0.477和0.914,P<0.01)。Spearman相关分析显示,血清TBIL及IBIL与平均最低动脉血氧饱和度呈正相关(P<0.05)。多元线性回归分析显示,TBIL与性别、高血压相关(P<0.05),IBIL与性别相关(P<0.05)。结论 OSAHS患者存在血清胆红素代谢异常,且在OSAHS合并CHD患者中更加明显,其与平均最低动脉血氧饱和度、性别及高血压有相关性,血清胆红素水平降低可能参与了OSAHS促CHD的发生过程。Objective To investigate the changes of serum bilirubin level in patients with OSAHS and in patients with OSAHS combined with CHD （ OSAHS ＋ CHD） , and to explore the pathophysiology changes in patients with OSAHS and the pathogenesis of OSAHS ＋ CHD. Methods 90 OSAHS patients admitted to the Department of Cardiology and Respiratory Medicine of our hospital in 2011 were randomly selected with 45 eases of OSAHS and 45 cases of OSAHS ＋ CHD. Meanwhile, 24 healthy subjects underwent physical examination in the same period were selected as eontrol group. Clinical data and serum bilirubin levels of the three groups were observed and the correlation of serum bilirubin level and polysomnography and clinical data of CHD was analyzed. Results The levels of TBIL and IBIL of the three groups showed statistically significant difference （ P 〈 0. 05 ） , and the pairwise difference was also statistically significant （ P 〈 0.05 ） . The DBIL level between the three groups showed no statisti- cally significant difference （ P 〉 0.05 ） . The correlation coefficient for serum TBIL and DBIL and for serum TBIL and DBIL was 0. 477 and 0. 914 respectively, and the difference was statistically significant （P 〈 0. 01 ） . The serum TBIL and IBIL were only positively correlated with the mean lowest SPaO2. TBIL was only related to sex and hypertension （P 〈 0. 05 ） and IBIL was only re- lated to sex （ P 〈 0. 05 ） . Conclusion OSAHS patients have abnormal metabolism of serum bilirubin, and it becomes even worse in OSAHS patients combined with CHD. The abnormal metabolism of bilirubin was related to mean lowest SPaO2, sex and hypertension, and the lower level of serum bilirubin may be involved in the pathogenesis of CHD promoted by OSAHS.

关 键 词：睡眠呼吸暂停 阻塞性 冠心病 胆红素 

分 类 号：R56[医药卫生—呼吸系统] R541.4[医药卫生—内科学]