糖化血红蛋白联合吸烟史预测老年OSAHS合并房性心律失常患者的临床价值研究  

The value of glycated hemoglobin and smoking in predicting essential obstructive sleep apnea hypopnea syndrome with atrial arrhythmia in elderly patients

作　　者：郭娜 闫新欣[1] 李向楠[1] 易忠[1] GUO Na;YAN Xinxin;LI Xiangnan;YI Zhong(Department of Geriatric,Aerospace Central Hospital,Beijing 100049,China)

机构地区：[1]航天中心医院老年医学一科,北京100049

出　　处：《现代医学与健康研究电子杂志》2022年第17期19-23,共5页Modern Medicine and Health Research

摘　　要：目的老年OSAHS患者合并房性心律失常发生率高,但由于患者及部分医护人员对该疾病的认识不足,导致诊断率偏低,目前有相关研究发现糖化血红蛋白(HbA1c)和吸烟史与OSAHS患者合并房性心律失常密切相关。现尝试分析HbA1c、吸烟史与老年OSAHS合并房性心律失常的关系,评估两者对老年OSAHS合并房性心律失常的预测价值。方法回顾性分析2018年11月至2020年1月期间于航天中心医院老年科就诊的阻塞性睡眠呼吸暂停低通气综合征的老年患者102例,患者均进行多导睡眠监测、24小时动态心电图监测,并完善HbA1c、空腹血糖等指标测定。根据睡眠呼吸暂停低通气指数(AHI)及24小时动态心电图结果分为OSAHS合并房性心律失常组30例和单纯OSAHS组48例。分析两组患者HbA1c、吸烟史情况,分别绘制HbA1c、吸烟史受试者工作特征(ROC)曲线,计算ROC曲线下面积(AUC)及最佳截断值;利用Logistic回归模型建模,用保存的概率作为单独变量绘制ROC曲线,分析两者联合预测OSAHS合并房性心律失常的价值。结果OSAHS合并房性心律失常组的年龄、空腹血糖、HbA1c、左房前后径显著高于单纯OSAHS组(P<0.05);OSAHS合并房性心律失常的发生与吸烟史、高血压史、冠心病史有关(P<0.05);空腹血糖与HbA1c呈正相关。吸烟史与房性心律失常、冠心病史、高血压史均呈正相关(P<0.05)。ROC曲线显示,联合诊断因子预测OSAHS合并房性心律失常的AUC为0.806,敏感度为86.7%、特异度为66.8%。结论HbA1c和吸烟史对老年OSAHS合并房性心律失常具有一定预测价值,对血糖控制不理想且合并吸烟史的老年OSAHS患者进行24小时动态心电图监测,以尽早发现房性心律失常,尤其是心房颤动,给予尽早干预治疗,从而降低合并症的发生风险。Objective The incidence of OSAHS with atrial arrhythmia is high in elderly patients.However,due to the difference in screening in the elderly general outpatient and lack of clinical understanding by patients and some medical staff,the diagnosis rate is still insufficient.Relevant studies have shown that the OSAHS with atrial arrhythmia is closely related to the history of glycated hemoglobin(HBA1C)and smoking.Now,we attempt to analyze the predictive value of HbA1c and smoking for OSAHS with atrial arrhythmia in elderly patients.Methods 102 elderly patients with OSAHS treated at the Geriatrics Department of Aerospace Central Hospital from November 2018 to January 2020 were enrolled in the study.All the enrolled patients were calculated by polysomnography 24 hours Holter Monitor monitoring,HbA1c,fasting blood glucose and other indicators.According to the apnea-hypopnea index(AHI)and the results of Holter Monitor,30 patients were divided into OSAHS with atrial arrhythmia group,and 48 patients were divided into OSAHS group.The levels of HbA1c and smoking history were compared between two groups.The receiver operating characteristic(ROC)curve of screening OSAHS patients complicated with atrial arrhythmia were determined by HbA1c and smoking.And the diagnosis value of area under AUC and different cut-off value were calculated.Logistic regression modeling was used to determine ROC curve with the saved probability as a separate variable to analyze the AUC of the two combined diagnosis of OSAHS and atrial arrhythmia.Results The age,fasting blood glucose,HbA1c and left atrial anteroposterior diameter of the OSAHS complicated with atrial arrhythmia group were significantly higher than the OSAHS group(P<0.05).The history of smoking,hypertension and coronary heart disease were related to the OSAHS complicated with atrial arrhythmia group(P<0.05).The fasting blood glucose was positively related to HbA1c.Smoking history was positively correlated with atrial arrhythmia,coronary heart disease and hypertension(P<0.05).The AUC of R

关 键 词：睡眠呼吸暂停低通气综合征 房性心律失常 心房颤动 糖化血红蛋白 

分 类 号：R441.8[医药卫生—诊断学]