阻塞性睡眠呼吸暂停低通气患者血清纤溶酶原激活物抑制剂1水平与颈动脉内膜中膜厚度及斑块稳定性的关系  

Correlation between serum plasminogen activator inhibitor-1 level and carotidintima-media thickness,plaque stability in patients with obstructive sleep apnea hypopnea syndrome

作　　者：陈丹 罗冬 CHEN Dan;LUO Dong(Department of Otorhinolaryngology,Baoji Municipal Central Hospital,Baoji,Shaanxi 721008,China;Department of Neurology,Baoji Municipal Central Hospital,Baoji,Shaanxi 721008,China)

机构地区：[1]宝鸡市中心医院耳鼻咽喉头颈外科,陕西省宝鸡市721008 [2]宝鸡市中心医院神经内科,陕西省宝鸡市721008

出　　处：《中国动脉硬化杂志》2023年第8期697-704,共8页Chinese Journal of Arteriosclerosis

基　　金：宝鸡市卫生局科研立项课题(201505)。

摘　　要：目的:探索阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血清纤溶酶原激活物抑制剂1(PAI-1)水平与颈动脉内膜中膜厚度(CIMT)及斑块稳定性的相关性。[方法]收集宝鸡市中心医院2019年7月—2021年1月行多导睡眠监测(PSG)的167例患者,基于睡眠呼吸暂停低通气指数(AHI)分为对照组(46例)、轻度OSAHS组(15例)、中度OSAHS组(39例)和重度OSAHS组(67例),比较各组一般临床资料、PSG相关指标、血生物化学指标、血清PAI-1水平和CIMT的差异。分析OSAHS患者血清PAI-1水平与CIMT和动脉硬化斑块稳定性的关系,根据CIMT及颈动脉斑块形态和超声学特征将OSAHS患者分为单纯OSAHS组(37例)、OSAHS稳定性斑块组(46例)和OSAHS不稳定性斑块组(38例),比较各组患者PAI-1水平,多因素Logistic回归分析探索OSAHS患者颈动脉斑块稳定性的危险因素。[结果]对照组、轻度OSAHS组、中度OSAHS组和重度OSAHS组之间性别、体质指数(BMI)、高血压病、吸烟史、AHI、氧减指数(ODI)、氧饱和度低于90%的时间占睡眠期的百分比(Ts90%)、睡眠最低指脉氧饱和度(L-SaO_(2))、CIMT、血清PAI-1水平差异有统计学意义(均P<0.05)。Pearson相关性分析提示OSAHS患者CIMT与血清PAI-1水平呈正相关(r=0.675,P<0.001),单纯OSAHS组的PAI-1水平为对照组的1.20倍,OSAHS稳定性斑块组的PAI-1水平为对照组的1.79倍,OSAHS不稳定性斑块组的PAI-1水平为对照组的2.01倍,差异有统计学意义(均P<0.05)。多元线性回归提示校准混杂因素影响后,CIMT与AHI(B=0.019,P=0.001)、血清PAI-1水平(B=0.012,P<0.001)、血低密度脂蛋白胆固醇(LDLC)浓度(B=0.081,P=0.028)独立相关。多因素Logistic回归分析结果显示校准混杂因素后,高血压(OR=4.121,95%CI:2.034~18.117)、糖尿病(OR=1.570,95%CI:1.158~3.645)、血清PAI-1水平(OR=1.091,95%CI:1.039~1.145)、中度OSAHS(OR=1.277,95%CI:1.162~3.730)、重度OSAHS(OR=5.834,95%CI:1.085~31.370)是OSAHS患者颈动脉斑块不稳定性的�Aim To investigate the serum plasminogen activator inhibitor-1(PAI-1)level in patients with obstructive sleep apnea hypopnea syndrome(OSAHS)and its correlation with carotid intima-media thickness(CIMT)and plaque stability.Methods 167 patients who underwent polysomnography(PSG)in Baoji Municipal Central Hospital from July 2019 to January 2021 were enrolled and divided into control group(n=46),mild OSAHS group(n=15),moderate OSAHS group(n=39),and severe OSAHS group(n=67)according to sleep apnea-hypopnea index(AHI).Clinical data,PSG-related indexes,blood biochemical indicators,serum PAI-1 level,and CIMT were compared in the three groups.The relationship between CIMT and serum PAI-1 concentration in OSAHS patients was analyzed.According to CIMT,carotid plaque morphology,and ultrasonographic features,OSAHS patients were divided into simple OSAHS group(n=37),OSAHS stable plaque group(n=46),and OSAHS unstable plaque group(n=38).PAI-1 level in each group was compared.Multivariate Logistic regression analysis was used to explore the risk factors of carotid plaque stability in OSAHS patients.Results There were statistically significant differences between the four groups regarding sex,body mass index(BMI),hypertension,smoking history,AHI,oxygen depletion index(ODI),oxygen saturation less than 90%of the time in sleeping time(Ts90%),the lowest nocturnal oxygen saturation(L-SaO_(2)),CIMT and serum PAI-1 level(P<0.05).Pearson correlation analysis showed that CIMT was positively correlated with PAI-1 level in OSAHS patients(r=0.675,P<0.001).The level of PAI-1 in the simple OSAHS group was 1.20 times,in the OSAHS stable plaque group was 1.79 times,and in the OSAHS unstable plaque group was 2.01 times that of the control group,and the difference had statistical significance(all P<0.05).Multiple linear regression suggested that CIMT was independently associated with AHI(B=0.019,P=0.001),PAI-1(B=0.012,P<0.001),and low density lipoprotein cholesterol(LDLC)(B=0.081,P=0.028)after calibrating confounders.Multivariate Logistic regressio

关 键 词：纤溶酶原激活物抑制剂1 阻塞性睡眠呼吸暂停低通气综合征 颈动脉内膜中膜厚度 动脉粥样硬化斑块 

分 类 号：R5[医药卫生—内科学]