阻塞性睡眠呼吸暂停低通气综合征患者血清Lp-PLA_(2)的变化及其并发动脉粥样硬化的危险因素分析  

Change of Serum Lp-PLA_(2) in Patients with Obstructive Sleep Apnea Hypopnea Syndrome and Risk Factors for Atherosclerosis Complication

作　　者：王林宣 顾文超[1] 奚峰[1] 杨华[1] 袁亚平[1] 尹育红[1] WANG Linxuan;GU Wenchao;XI Feng;YANG Hua;YUAN Yaping;YIN Yuhong(Department of Respiratory and Critical Care Medicine,Shanghai Pudong New Area People's Hospital,Shanghai 201200,China)

机构地区：[1]上海市浦东新区人民医院呼吸与危重症医学科,上海201200

出　　处：《医学综述》2021年第17期3520-3524,共5页Medical Recapitulate

基　　金：上海市浦东新区卫生系统优秀青年医学人才培养计划(PWRq2017-08);上海市浦东新区卫生系统重点学科建设计划(PWZxk2017-24)。

摘　　要：目的分析阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血清脂蛋白相关磷脂酶A2(Lp-PLA_(2))水平的变化及其并发动脉粥样硬化(As)的危险因素。方法回顾性分析2017年12月至2019年12月于上海市浦东新区人民医院行多导睡眠监测(PSG)的152例患者的临床资料。根据PSG的结果分为非OSAHS组(45例)、轻中度OSAHS组(51例)、重度OSAHS组(56例),进一步将OSAHS患者分为合并As组(31例)和不合并As组(76例),比较各组的血清Lp-PLA_(2)水平,并分析OSAHS患者血清Lp-PLA_(2)水平与PSG参数的相关性及OSAHS并发As的危险因素。结果 3组患者的性别、年龄、体质指数和合并高血压、合并糖尿病、合并As患者比例以及AHI、ODI、LSpO_(2)、Lp-PLA_(2)比较差异有统计学意义(P<0.05或P<0.01)。轻中度OSAHS组和重度OSAHS组的男性患者比例、合并高血压、合并糖尿病、合并As患者比例均高于非OSAHS组(均P<0.05);轻中度OSAHS组和重度OSAHS组年龄大于非OSAHS组,且重度OSAHS组大于轻中度OSAHS组(P<0.01);轻中度OSAHS组和重度OSAHS组的体质指数、AHI、ODI、血清Lp-PLA_(2)水平均高于非OSAHS组,且重度OSAHS组高于轻中度OSAHS组(均P<0.01);重度OSAHS组的LSpO_(2)低于轻中度OSAHS组和非OSAHS组(P<0.01)。血清Lp-PLA_(2)水平与ODI呈正相关(P<0.05),与AHI、LSpO_(2)无相关性(P>0.05)。合并As组OSAHS患者的血清Lp-PLA_(2)水平高于不合并As组[(124.9±18.1)μg/L比(107.1±13.7)μg/L](P<0.01)。Logistic回归分析结果显示,年龄、体质指数、吸烟史和血清Lp-PLA_(2)水平是OSAHS合并As的独立危险因素(P<0.05)。结论血清Lp-PLA_(2)水平随OSAHS严重程度的增加而升高,且是OSAHS患者并发As的独立危险因素。Objective To analyze the change of serum lipoprotein associated phospholipase A2(Lp-PLA_(2)) levels in patients with obstructive sleep apnea hypopnea syndrome(OSAHS) and the risk factors for complicated atherosclerosis(As).Methods The clinical data of 152 patients who underwent polysomnography(PSG) in Shanghai Pudong New Area People′s Hospital from Dec.2017 to Dec.2019 were retrospectively analyzed.According to the PSG results, the patients were divided into a non-OSAHS group(45 cases),a mild to moderate OSAHS group(51 cases) and a severe OSAHS group(56 cases),and the OSAHS patients were also divided into an As complication group(31 cases) and a non-As complication group(76 cases).The levels of serum Lp-PLA_(2) in each group were compared, and the correlation between serum Lp-PLA_(2)levels and PSG parameters and the risk factors of As complication in OSAHS patients were analyzed.Results There were significant differences in gender, age, body mass index(BMI) and the proportion of patients with hypertension, diabetes mellitus, As and AHI,ODI,LSpO_(2) and Lp-PLA_(2) between the 3 groups(P<0.05 or P<0.01).Male patients, the proportion of patients with hypertension, diabetes mellitus and As in the mild to moderate OSAHS group and the severe OSAHS group were higher than those in the non-OSAHS group(all P<0.05).The age in the mild to moderate OSAHS group and the severe OSAHS group was higher than that in the non-OSAHS group, and that in the severe OSAHS group was higher than that in the mild to moderate OSAHS group(P<0.01).The BMI,AHI,ODI and serum Lp-PLA_(2) in the mild to moderate OSAHS group and the severe OSAHS group were higher than those in the non-OSAHS group, and those in the severe OSAHS group were higher than those in the mild to moderate OSAHS group(all P<0.01).LSpO_(2) in the severe OSAHS group was lower than that in the mild to moderate OSAHS group and the non-OSAHS group(P<0.01).The level of serum Lp-PLA_(2) was positively correlated with ODI(P<0.05),and was not correlated with AHI and LSpO_(2)(P>0.05).T

关 键 词：阻塞性睡眠呼吸暂停低通气综合征 脂蛋白相关磷脂酶A2 动脉粥样硬化 

分 类 号：R766.7[医药卫生—耳鼻咽喉科]