阻塞性睡眠呼吸暂停低通气综合征病程因素对儿童生长发育异常程度的影响  

Impact of disease course of obstructive sleep apnea-hypopnea syndrome on growth and development in children

作　　者：朱瑾[1] 陈鑫[1] 王海飞[1] 方瑜[1] 余道军[2] 沈毅[3] 

机构地区：[1]南京医科大学附属杭州医院耳鼻咽喉头颈外科,310006 [2]南京医科大学附属杭州医院基因实验室,310006 [3]浙江大学医学院公共卫生系

出　　处：《浙江医学》2013年第16期1481-1486,共6页Zhejiang Medical Journal

基　　金：杭州市科技发展计划项目(20100633B03)

摘　　要：目的通过检测血清胰岛素样生长因子-1（IGF-1）和胰岛素样生长因子结合蛋白-3（IGFBP-3），研究阻塞性睡眠呼吸暂停低通气综合征（OSAHS）病程因素对儿童生长发育的影响。方法51例经多导睡眠监测（PSG）确诊为OSAHS的5~12岁且未进入青春发育期患儿行双侧扁桃体＋腺样体或单纯腺样体切除术，并在术前、术后3个月、术后6个月3个时点（下称第1、2、3时点）分别进行IGF-1、IGFBP-3和PSG检测。72例同年龄段未进入青春发育期正常儿童设为对照组。51患儿按病程分为病程＜5年组和病程≥5年组，病程＜5年组25例，病程≥5年组26例。不同病程组患儿术前性别、身高体重指数（BMI）、病情严重程度等基本特征分布均衡，差异无统计学意义（均P＞0.05）。结果51例患儿的IGF-1、IGFBP-3各时点均值分别与正常对照组均值进行比较差异均有统计学意义（均P＜0.001），患儿术后6个月时，除个别病例外，其余2项指标均在正常值范围内，但总体均值尚未达到正常对照组水平（P＜0.001）。重复测量方差分析显示不同病程组患儿的IGF-1、IGFBP-3各时点的均值均随时间改善，且差异有统计学意义（IGF-1：F=341.26，IGFBP-3：F=357.75，均P＜0.001）。同时，不同病程组各时点的IGF-1、IGFBP-3均值组间比较差异均有统计学意义（IGF-1：F=78.72，IGFBP-3：F=49.32，均 P＜0.001），且IGF-1在不同病程组间存在时间和病程的交互作用（F=84.65，P＜0.001）。不同病程组患儿的呼吸暂停低通气指数（AHI）、最低动脉血氧饱和度（LaSO2）均值组内各时点间比较差异均有统计学意义（AHI：F=99.057，；LaSO2：F=70.742，均P＜0.001）；组间比较差异均无统计学意义（AHI：F=0.082，P=0.775；LaSO2：F=1.382，P=0.255）。AHI和LaSO2均不存在时间和病程的交互作用。结论 OSAHS对儿童生长发育有明显的影响，手术干预后逐步恢复。病�Objective To investigate the impact of disease course of obstructive sleep apnea- hypopnea syndrome （OS-AHS） on growth and development in children. Methods Fifty- one prepuberty children aged 5~12 were diagnosed as OSAHS by polysomnography （PSG）. The adenotonsillectomy and/or adenoidectomy were performed. Serum levels of insulin- like growth factor- 1（IGF- 1） and insulin- like growth factor binding protein- 3（IGFBP- 3） were determined before, 3 and 6 months after surgery （T1, T2 and T3） and PSG examinations were also performed at the same time points. Seventy two prepuberty normal children with same ages served as controls. Among 51 OSAHS children the disease course was〈5y in 25 cases （group A） and that was≥5y in 26 cases （group B）. The SPSS 19.0 was used for statistical analysis. Results There were significant differences in serum IGF- 1 and IGFBP- 3 levels in al time point between OSAHS children and the controls （P〈0.001）. Balance test showed that there were no statistical differences in gender, body mass index （BMI） and disease severity among group A, B and control before surgery （al P〉0.05）. Repetitive measurement and variance analysis showed that there were statistical differences in means of IGF- 1, IGFBP- 3 at al time points between two groups （IGF- 1：F=341.26, P〈0.001;IGFBP- 3：F=357.75, P〈0.001）. The in-dexes were improved with the disease courses, and there were statistical differences in serum IGF- 1 and IGFBP- 3 levels at al time points between two groups （IGF- 1：F=78.72, P〈0.001;IGFBP- 3：F=49.32, P〈0.001）. IGF- 1 had interation effect of dis-ease courses among groups（F=84.65, P〈0.001）. There were significant differences in AHI and LaSO2 values at 3 time points in two groups （AHI：F=99.057, P〈0.001;LaSO2：F=70.742, P〈0.001）, however there were no statistical difference （AHI：F=0.082 P=0.775;LaSO2：F=1.382, P=0.255） between groups. AHI and LaSO2 did not have interation effect of disease courses. Con-clusion The

关 键 词：阻塞性 睡眠呼吸暂停 儿童 病程 生长 

分 类 号：R766[医药卫生—耳鼻咽喉科]