阻塞性睡眠呼吸暂停综合征患者房性心律失常与V1导联P波终末电势及左心房直径的相关性  

Correlation between atrial arrhythmia and V1 lead P wave terminal potential and left atrial diameter in patients with obstructive sleep apnea syndrome

作　　者：曾晓杰 温华知[2] 朱红红 谢萍[2] 谢宇平[3] Zeng Xiao-Jie;Wen Hua-Zhi;Zhu Hong-Hong;Xie Ping;Xie Yu-Ping(Clinical Medical College of Gansu University of Traditional Chinese Medicine,Lanzhou 730000,China;Department of Cardiology,Gansu Provincial People's Hospital,Lanzhou 730000,China;Snoring Department,Gansu Provincial People's Hospital,Lanzhou 730000,China)

机构地区：[1]甘肃中医药大学临床医学院,兰州730000 [2]甘肃省人民医院心内科,兰州730000 [3]甘肃省人民医院鼾病科,兰州730000

出　　处：《解放军医学杂志》2020年第6期627-632,共6页Medical Journal of Chinese People's Liberation Army

基　　金：国家自然科学基金(81360038,81100133)。

摘　　要：目的探讨阻塞性睡眠呼吸暂停综合征(OSAS)患者房性心律失常的发生与V1导联P波终末电势(PTFV1)、左心房直径(LAD)的相关性。方法纳入2017年9月-2019年4月在甘肃省人民医院鼾病科初次住院的247例OSAS患者。根据呼吸暂停低通气指数(AHI)将OSAS患者分为4组:AHI<5为对照组(n=22),5≤AHI<15为轻度OSAS组(n=37);15≤AHI<30为中度OSAS组(n=46);AHI≥30为重度OSAS组(n=142)。收集研究对象睡眠呼吸监测指标,通过动态心电图观察房性心律失常发生率,超声心动图测量LAD,12导联心电图测量PTFV1。比较各组房性心律失常的发生情况,分析房性心律失常与PTFV1及LAD相关性。结果轻、中、重度OSAS组房性心律失常的发生率(分别为16.2%、23.9%、17.6%)均明显高于对照组(0,P<0.05),但轻、中、重度OSAS组间比较差异无统计学意义。PTFV1与OSAS患者房性心律失常的发生率呈正相关(r=0.394,P<0.01);LAD与OSAS患者房性心律失常的发生率呈正相关(r=0.235,P<0.01)。结论OSAS患者房性心律失常的发生与异常升高的PTFV1及LAD相关,考虑可能与左心房的电重构及结构重构有关。Objective To investigate the correlation of atrial arrhythmia with V1 lead P wave terminal potential(PTFV1)and left atrial diameter(LAD)in patients with obstructive sleep apnea syndrome(OSAS).Methods A total of 247 suspected OSAS patients,firstly hospitalized in Snoring Department of Gansu Provincial People's Hospital from Sep.2017 to Apr.2019,were included,and divided into four groups according to the apnea hypopnea index(AHI):AHI<5 as the control group(n=22),5≤AHI<15 as the mild OSAS group(n=37),15≤AHI<30 as the moderate OSAS group(n=46),and AHI≥30 as the severe OSAS group(n=142).Polysomnography(PSG)were collected,the incidence of atrial arrhythmia was observed by 24-h dynamic electrocardiogram,LAD was measured by echocardiography,and PTFV1 was measured by 12-lead electrocardiogram.The incidence of atrial arrhythmia in each group was compared,and the correlation between the occurrence of atrial arrhythmia and PTFV1 and LAD was analyzed.Results The incidences of atrial arrhythmia in the mild,moderate and severe group(16.2%,23.9%and 17.6%,respectively)were significantly higher than that in the control group(0,P<0.05),but no significant difference existed among the mild,moderate and severe group.PTFV1 was positively associated with the incidence of atrial arrhythmia in patients with OSAS(r=0.394,P<0.01).LAD was positively correlated with the incidence of atrial arrhythmia in patients with OSAS(r=0.235,P<0.01).Conclusion The occurrence of atrial arrhythmia in OSAS patients is associated with the abnormal increase of PTFV1 and LAD,which indicates that the occurrence of atrial arrhythmia in OSAS patients is related to the electrical and structural remodeling of the left atrium.

关 键 词：阻塞性睡眠呼吸暂停综合征 心房颤动 房性心律失常 V1导联P波终末电势 左心房直径 

分 类 号：R766[医药卫生—耳鼻咽喉科] R541.7[医药卫生—临床医学]