急性缺血性脑卒中合并阻塞性睡眠呼吸暂停低通气综合征患者的临床特征  

Clinical characteristics of acute ischemic stroke patients complicated with obstructive sleep apnea hypopnea syndrome

作　　者：吴华蔓 宋国强 李洁[2] 许娟 蔡思洁 王婧[1] 王巧军 韩菲[2] 陈锐[1] Wu Huaman;Song Guoqiang;Li Jie;Xu Juan;Cai Sijie;Wang Jing;Wang Qiaojun;Han Fei;Chen Rui(Department of Respiratory and Critical Care Medicine,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China;Sleep Center,Department of Neurology,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China;Department of Respiratory and Critical Care Medicine,the First People′s Hospital of Kunshan City,Kunshan 215300,China)

机构地区：[1]苏州大学附属第二医院呼吸科与危重症医学科,苏州215004 [2]苏州大学附属第二医院神经内科睡眠中心,苏州215004 [3]昆山市第一人民医院呼吸与危重症医学科,昆山215300

出　　处：《中华健康管理学杂志》2021年第2期122-128,共7页Chinese Journal of Health Management

基　　金：国家自然科学基金(81770085,82070095);苏州大学附属第二医院学科建设托举工程(XKTJ-TD202003)。

摘　　要：目的分析急性缺血性脑卒中(AIS)合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的临床特征。方法回顾性收集2015年1月至2020年6月因AIS在苏州大学附属第二医院就诊且在睡眠中心行多导睡眠监测(PSG)的患者资料,根据呼吸暂停低通气指数(AHI)将所有患者分成OSAHS组和单纯AIS组。收集所有患者的基本信息、一般临床资料、血液学指标包括糖脂代谢指标和炎症指标、PSG参数、神经功能评分量表包括入院时的美国国立卫生研究院卒中量表(NIHSS)和出院时的改良Rankin量表(mRS),比较上述指标在两组之间的差异。另外,根据mRS评分将OSAHS组分为预后良好组和预后不良组,比较两组之间的差异。结果共纳入OSAHS组112例,单纯AIS组89例。OSAHS组的非快眼动睡眠1+2期(N1+N2)比例、觉醒指数、氧减指数(ODI)、脉氧饱和度<90%时间占总睡眠时间百分比(TS90)均显著高于单纯AIS组,而N3期比例、夜间最低脉氧饱和度(LSaO2)均显著低于单纯AIS组(均P<0.05)。两组脑卒中病灶分布(皮质、皮质下、脑干、小脑)差异无统计学意义,但OSAHS组发生多部位脑卒中者占比更大(P=0.032)。两组入院NIHSS评分差异无统计学意义,但OSAHS组的中性粒细胞计数与淋巴细胞计数比值(NLR)(P=0.004)和出院mRS评分(P=0.010)均明显高于单纯AIS组。OSAHS患者中预后良好组74例,预后不良组38例,预后不良组的入院NIHSS评分和NLR均高于预后良好组,入院NIHSS评分是预后不良的危险因素(均P<0.01)。结论AIS合并OSAHS患者具有睡眠结构紊乱、夜间低氧更严重、发生多部位卒中的比例高、出院时神经功能恢复状况差、炎症指标NLR高的特点;其中预后不良者睡眠效率更差,入院NIHSS评分高是预后不良的危险因素。Objective To analyze the clinical characteristics of patients suffering from acute ischemic stroke(AIS)complicated with obstructive sleep apnea-hypopnea syndrome(OSAHS).Methods Data of patients with AIS who visited the Second Affiliated Hospital of Soochow University from January 2015 to June 2020 and underwent polysomnography monitoring(PSG)in the sleep center were collected retrospectively.Patients were divided into OSAHS group and AIS only group.Demographic information of patients,general clinical data,hematological indicators of glucose and lipid metabolism and inflammatory markers,PSG parameters and neurological function scores were collected,including the National Institutes of Health Stroke Scale(NIHSS)on admission and the modified Rankin Scale(mRS)on discharge.We compared the differences between the two groups.In addition,OSAHS group were divided into good prognosis and poor prognosis subgroups according to mRS score.The differences between the two subgroups were compared.Results A total of 112 AIS patients combined with OSAHS and 89 AIS only patients were included.The proportion of non-rapid eye movement stages 1+2[(N1+N2)%],arousal index,the oxygen desaturation index(ODI),percentage of total sleep time with oxygen saturation<90%(TS90)in the OSAHS group were higher than those in the AIS only group,while N3%,lowest nocturnal oxygen saturation(LSaO2)were lower(all P<0.05).There was no statistical difference in the distribution of cerebral apoplexy lesions(cortex,subcortical,brainstem,cerebellum)between the two groups,but the proportion of patients with multifocal cerebral apoplexy in the OSAHS group was higher(P=0.032).There was no statistical difference in NIHSS score on admission between the two groups,but the neutrophil/lymphocyte ratio(NLR)score(P=0.004)and mRS score on discharge(P=0.010)of the OSAHS group were significantly higher than those in the AIS only group.There were 74 patients in the good prognosis group and 38 in the poor prognosis group.The analysis showed that the NIHSS and NLR scores of t

关 键 词：卒中 脑缺血 睡眠呼吸暂停 阻塞性 疾病特征 

分 类 号：R766[医药卫生—耳鼻咽喉科] R743.3[医药卫生—临床医学]