阻塞性睡眠呼吸暂停对慢性阻塞性肺疾病患者心肺功能的影响  

Effect of obstructive sleep apnea on cardiopulmonary function in patients with chronic obstructive pulmonary disease

作　　者：沈久成[1] 孙丽 王婧[1] 杜紫燕[1] 陈锐[1] Shen Jiucheng;Sun Li;Wang Jing;Du Ziyan;Chen Rui(Department of Respiratory and Critical Medicine,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China;Department of Respiratory and Critical Medicine,the Fourth Affiliated Hospital of Zhejiang University School of Medicine,Yiwu 322000,China)

机构地区：[1]苏州大学附属第二医院呼吸与危重医学科,苏州215004 [2]浙江大学医学院附属第四医院呼吸与危重医学科,义乌322000

出　　处：《中华医学杂志》2021年第22期1665-1670,共6页National Medical Journal of China

基　　金：国家自然科学基金(81770085,82070095);苏州大学附属第二医院科技创新团队托举项目(XKTJ-TD20203)。

摘　　要：目的探讨慢性阻塞性肺疾病(COPD)合并阻塞性睡眠呼吸暂停(OSA)的重叠综合征(OS)患者心肺功能的临床特征。方法收集2017年12月至2019年12月苏州大学附属第二医院经治疗病情稳定的COPD患者,进行睡眠监测检查,根据睡眠呼吸暂停低通气指数(AHI)将149例患者分成OS组56例和COPD组93例,对两组的睡眠监测参数、肺功能、动脉血气分析及氨基末端脑钠尿肽(NT-proBNP)等数据进行对比,分析OS患者心肺功能的临床特征及与AHI的相关性。结果两组间年龄、性别差异无统计学意义(均P>0.05)。与COPD组相比,OS组患者第一秒用力呼气容积占用力肺活量百分比(FEV_(1)/FVC)、第一秒用力呼气容积占预计值百分比(FEV_(1)%预计值)、pH值[M(Q_(1),Q_(3))]、氧分压(PaO_(2))与血氧饱和度(SaO_(2))下降[(49.46±12.98)%比(54.38±11.72)%,(47.86±14.78)%比(57.78±15.81)%,7.37(7.34,7.39)比7.40(7.39,7.41),(80.75±10.20)比(84.28±8.43)mmHg(1 mmHg=0.133 kPa),(94.46±2.52)%比(95.74±2.28)%],而二氧化碳分压(PaCO_(2))[M(Q_(1),Q_(3))]升高[55.00(45.50,60.00)比44.00(40.00,48.00)mmHg](均P<0.05)。OS组肺动脉压及血浆NT-proBNP水平[M(Q_(1),Q_(3))]均高于COPD组[38.90(28.60,49.05)比28.60(24.95,32.60)mmHg,434.00(273.75,631.00)比136.00(86.00,205.00)pg/ml](均P<0.05)。AHI与PaCO_(2)、肺动脉压、NT-proBNP及急性加重次数呈正相关(r=0.496、0.544、0.628、0.446,均P<0.05),与FEV_(1)/FVC、FEV_(1)%预计值、pH值、PaO_(2)及SaO_(2)呈负相关(r=-0.309、-0.346、-0.410、-0.289、-0.267,均P<0.05)。结论OS患者出现更严重的低氧血症、高碳酸血症及肺功能损伤,其NT-proBNP及肺动脉压水平较COPD患者明显升高。Objective To study the characteristics of cardiopulmonary function in patients with chronic obstructive pulmonary disease(COPD)and obstructive sleep apnea(OSA)overlapping syndrome(OS).Methods A total of 149 COPD patients,who were on stable treatment,were enrolled from the Second Affiliated Hospital of Soochow University from December 2017 to December 2019.The patients were divided into the OS group(n=56)and the COPD only group(n=93)according to their apnea hypopnea index(AHI)measured by the Apnealink device.Data were gathered from polysomnograph(PSG),spirometry,arterial blood gas and N-terminal pro-brain natriuretic peptide(NT-proBNP)assay to assess the cardiopulmonary function of patients.Partial correlation analysis was used to analyze the correlation between AHI and various factors,to study the characteristic changes in the cardiopulmonary function of these OS patients.Results There were no significant cross-group differences in age and gender(all P>0.05).In the OS group,the forced expiratory volume in one second to forced vital capacity ratio(FEV_(1)/FVC),the forced expiratory volume in the first second expressed as percent predicted(FEV_(1)%pred),pH[M(Q_(1),Q_(3))],partial pressure of oxygen(PaO_(2))and oxygen saturation(SaO_(2))were lower than those in the COPD group[(49.46±12.98)%vs(54.38±11.72)%,(47.86±14.78)%vs(57.78±15.81)%,7.37(7.34,7.39)vs 7.40(7.39,7.41),(80.75±10.20)vs(84.28±8.43)mmHg(1 mmHg=0.133 kPa),(94.46±2.52)%vs(95.74±2.28)%],whereas partial pressure of carbon dioxide(PaCO_(2))[M(Q_(1),Q_(3))]was higher than that in the COPD group[55.00(45.50,60.00)vs 44.00(40.00,48.00)mmHg](all P<0.05).Pulmonary arterial pressure and plasma NT-proBNP levels[M(Q_(1),Q_(3))]in the OS group were significantly higher than those in the COPD group[38.90(28.60,49.05)vs 28.60(24.95,32.60)mmHg,434.00(273.75,631.00)vs 136.00(86.00,205.00)pg/ml](P<0.05).Partial correlation analysis showed that AHI was positively correlated with PaCO_(2),pulmonary artery pressure,NT-proBNP,and acute exacerbation events(r values:0

关 键 词：睡眠呼吸暂停 阻塞性 肺疾病 慢性阻塞性 重叠综合征 肺动脉压 氨基末端脑钠尿肽 

分 类 号：R563.9[医药卫生—呼吸系统] R766[医药卫生—内科学]