阻塞性睡眠呼吸暂停低通气综合征合并慢性阻塞性肺疾病患者的心肺功能、缺氧程度及炎症因子变化的临床意义  

Clinical significance of changes in cardiopulmonary function,degree of hypoxia and inflammatory factors in OSAHS patients combined with COPD

作　　者：李艳华[1] 袁开芬[1] 曹丽娇 尹粉英 马建芳 黄晓玲 LI Yanhua;YUAN Kaifen;CAO Lijiao;YIN Fenying;MA Jianfang;HUANG Xiaoling(Department of General Medicine,The Second Affiliated Hospital of Kunming Medical University,Kunming,Yunnan 650051,P.R.China)

机构地区：[1]昆明医科大学第二附属医院全科医学科,云南昆明650051

出　　处：《中国呼吸与危重监护杂志》2022年第9期629-635,共7页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的研究阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)合并慢性阻塞性肺疾病(简称慢阻肺)患者的心肺功能、缺氧程度及炎症因子变化的临床意义。方法采用病例对照研究,回顾性分析2015年10月至2022年4月收治的209例OSAHS患者的临床资料。依据肺功能将OSAHS患者分为单纯OSAHS组、OSAHS合并轻度慢阻肺组、OSAHS合并中度慢阻肺组和OSAHS合并重度极重度慢阻肺组。分别比较OSAHS组以及OSAHS合并不同程度慢阻肺组患者的心肺功能[肺动脉压、氨基末端脑钠肽前体(N terminal pro B type natriuretic peptide,NT-proBNP)、第1秒用力呼气容积(forced expiratory volume in the first second,FEV_(1))与用力肺活量(forced vital capacity,FVC)的比值(FEV_(1)/FVC)、FEV_(1)占预计值百分比(percent predicted value,%pred)],缺氧指标[夜间最低脉氧饱和度(night lowest saturation of pulse oxygen,NL-SpO_(2))、夜间平均脉氧饱和度(night medial saturation of pulse oxygen,NM-SpO_(2))、夜间脉氧饱和度<85%的时间(saturation of pulse oxygen less than 85%of the time,TS85)、日间最低脉氧饱和度(diurnal lowest saturation of pulse oxygen,DL-SpO_(2))],炎症因子指标[降钙素原(procalcitonin,PCT)、白细胞介素6(interleukin-6,IL-6)、高敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)、中性粒细胞淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)]等的差异。采用偏相关分析和Logistic回归分析OSAHS合并慢阻肺发病影响因素。结果OSAHS合并慢阻肺组与单纯OSAHS组相比,年龄、住院时间、心肺功能指标、缺氧指标和炎症因子指标差异有统计学意义(均P<0.05)。其中,合并重度极重度慢阻肺组与合并轻度慢阻肺组相比,肺动脉压、NT-proBNP、TS85、IL-6、NLR较高,DL-SpO_(2)、NL-SpO_(2)、NM-SpO_(2)较低(均P<0.05)。偏相关分析中,FEV_(1)%pred与肺动脉压、NT-proBNP、TS85、IL-6、hs-CRP、NLR呈负相关,与DL-SpO_(2)、NL-SpO_(2Objective To investigate the clinical significance of changes in cardiopulmonary function,degree of hypoxia and inflammatory factors in obstructive sleep apnea hypopnea syndrome(OSAHS)patients combined chronic obstructive pulmonary disease(COPD).Methods A retrospective case-control study was conducted on 209 patients with OSAHS admitted from October 2015 to April 2022.The OSAHS patients were divided into an OSAHS-only group,an OSAHS combined with mild COPD group,an OSAHS combined with moderate COPD group,and an OSAHS combined with severe and very severe COPD group based on pulmonary function test.The characteristics of cardiopulmonary function[pulmonary artery pressure,N terminal pro B type natriuretic peptide(NT-proBNP),forced expiratory volume in the first second to forced vital capacity(FEV_(1)/FVC),percent predicted value of FEV_(1)(FEV_(1)%pred)],hypoxia indexes[night lowest saturation of pulse oxygen(NL-SpO_(2)),night medial saturation of pulse oxygen(NM-SpO_(2)),saturation of pulse oxygen less than 85% of the time(TS85),diurnal lowest saturation of pulse oxygen(DL-SpO_(2))],inflammatory factor indicators[procalcitonin(PCT),interleukin-6(IL-6),hypersensitive C-reactive protein(hs-CRP),neutrophil to lymphocyte ratio(NLR)],and other characteristics were compared separately.The partial correlation analysis and logistic regression were used to analyze the influencing factors of OSAHS with COPD.Results There were statistically significant differences in age,days of hospitalization,cardiopulmonary function indexes,hypoxia indexes and inflammatory factor indexes between the OSAHS combined with COPD group and the OSAHS-only group(all P<0.05).And pulmonary artery pressure,NT-proBNP,TS85,IL-6,and NLR were higher and DL-SpO_(2),NL-SpO_(2),and NM-SpO_(2)were lower in the OSAHS combined with severe and very severe COPD group compared with the OSAHS combined with mild COPD group(all P<0.05).In the partial correlation analysis,FEV_(1)%pred was negatively correlated with pulmonary artery pressure,NT-proBNP,TS85,IL-6,hs-CRP

关 键 词：阻塞性睡眠呼吸暂停综合征 慢性阻塞性肺疾病 炎症因子 心肺功能 缺氧 

分 类 号：R766[医药卫生—耳鼻咽喉科] R563.9[医药卫生—临床医学]