脑梗死合并阻塞性睡眠呼吸暂停低通气综合征患者颅内血管狭窄临床分析  

Clinical analysis of intracranial vascular stenosis in patients with cerebral infarction and obstructive sleep apnea-hypopnea syndrome

作　　者：张燕平[1] 罗瑞琦 焦永光 李运恒 ZHANG Yanping;LUO Ruiqi;JIAO Yongguang;LI Yunheng(The First Affiliated Hospital of Henan University of Traditional Chinese Medicine,Zhengzhou 450000,China)

机构地区：[1]河南中医药大学第一附属医院,河南郑州450000

出　　处：《中国实用神经疾病杂志》2020年第8期650-654,共5页Chinese Journal of Practical Nervous Diseases

基　　金：河南省中医药科学研究专项课题(编号:2017ZY2042);河南省高等学校重点科研项目计划(编号:17A320025)。

摘　　要：目的评估脑梗死合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者颅内血管狭窄的风险。方法选取2017-07—2019-10河南中医药大学第一附属医院的70例急性脑梗死患者,行多导睡眠图(polysomnography,PSG)监测,依据呼吸暂停指数(apnea and hypophea index,AHI)≥5次/h的结果,将诊断为OSAHS合并脑梗死患者35例纳入实验组;无OSAHS的脑梗死患者为对照组。抽取患者空腹静脉血,分别测定同型半胱氨酸、C反应蛋白水平,各组均行头颅磁共振MRA检查,按狭窄情况分为无狭窄、轻度狭窄与重度狭窄。比较脑梗死合并OSAHS与无OSAHS的脑梗死患者血清同型半胱氨酸、C反应蛋白的水平变化,颅内血管狭窄的程度、数量及分布情况。结果对照组体重指数(BMI)为(23.29±1.85)kg/m2,实验组为(25.53±3.95)kg/m2,实验组明显高于对照组(P<0.05)。实验组中CRP为(4.56±3.17)mg/dL,对照组为(2.50±1.77)mg/dL,实验组明显高于对照组(P<0.05)。对照组Hcy为(13.56±5.20)mg/dL,实验组为(17.71±9.05)mg/dL,实验组明显高于对照组(P<0.05),2组年龄差异无统计学意义(P>0.05)。实验组颅内动脉狭窄患者占68.6%(24/35),对照组狭窄仅为48.5%(17/35);实验组多支狭窄37.1%(13/35),而对照组为17.1%(6/35);2组在脑动脉狭窄程度、数量上差异有统计学意义(P<0.05),颅内血管分布则无明显差异(P>0.05)。结论OSAHS增加颅内血管狭窄的风险,应重视对脑梗死患者睡眠呼吸功能的监测和干预。Objective To assess the risk of intracranial stenosis in patients with cerebral infarction with obstructive sleep apnea-hypopnea syndrome(OSAHS).Methods 70 patients with acute cerebral infarction who came to our hospital from July 2017 to October 2019 were selected for polysomnography figure(polysomnography,PSG)monitoring,based on the results of the apnea index(apnea and hypopnea index,AHI)≥5 times/h.Thirty-five patients diagnosed with OSAHS and cerebral infarction were included in the experimental group;patients with cerebral infarction without OSAHS were used as the control group.All the subjects were cleared of fasting venous blood,and the contents of homocysteine and C-reactive protein were measured.Each group was subjected to a skull MRA test.According to stenosis,it can be divided into non-stenosis,mild stenosis and severe stenosis.The changes of serum homocysteine and C-reactive protein content,and the degree,quantity and distribution of intracranial vascular stenosis in patients with cerebral infarction combined with OSAHS and without cerebral infarction were compared.Results In the control group,the average body mass index(BMI)was(23.29±1.85)kg/m2,and the experimental group was(25.53±3.95)kg/m2.The comparison between the two groups was P<0.004,and the difference was significant.In the experimental group,the CRP was(4.56±3.17)mg/dL,and the CRP in the control group was(2.50±1.77)mg/dL.The comparison between the two groups was P<0.002,and the difference was significant.The Hcy in the control group was(13.56±5.20)mg/dL,and the Hcy in the experimental group was(17.71±9.05)mg/dL.There was a statistical difference between the two groups with P<0.015,and the age difference was not significant.The proportion of patients with intracranial arterial stenosis in the experimental group was 68.6%(24/35),while the stenosis in the control group was only 48.5%(17/35).The number of stenosis in the experimental group was 37.1%(13/35),compared with 17.1%(6/35)in the control group.There was a significant difference in

关 键 词：脑梗死 阻塞性睡眠呼吸暂停低通气综合征 睡眠呼吸功能 颅内动脉血管狭窄 多导睡眠图 C反应蛋白 同型半胱氨酸 

分 类 号：R743.33[医药卫生—神经病学与精神病学]