夜间呻吟症患者颅颌面解剖特征研究  

Craniofacial anatomical characteristics of patients with catathrenia

作　　者：于敏 郝泽良[1] 许力月[2] 温永飞 韩芳[2] 高雪梅[1] Yu Min;Hao Zeliang;Xu Liyue;Wen Yongfei;Han Fang;Gao Xuemei(Department of Orthodontics,Peking University School and Hospital of Stomatology&National Center for Stomatology&National Clinical Research Center for Oral Diseases&National Engineering Research Center of Oral Biomaterials and Digital Medical Devices&Beijing Key Laboratory of Digital Stomatology,Beijing 100081,China;Sleep Division,Peking University People′s Hospital,Beijing 100044,China)

机构地区：[1]北京大学口腔医学院·口腔医院正畸科、国家口腔医学中心、国家口腔疾病临床医学研究中心、口腔生物材料和数字诊疗装备国家工程研究中心、口腔数字医学北京市重点实验室,北京100081 [2]北京大学人民医院呼吸睡眠医学科,北京100044

出　　处：《中华口腔医学杂志》2023年第7期659-668,共10页Chinese Journal of Stomatology

基　　金：国家自然科学基金(81670082)。

摘　　要：目的利用影像学手段和鼻阻力测试对夜间呻吟症(catathrenia)患者颅颌面解剖特征进行研究,探讨该病病因并为后续临床治疗提供参考。方法纳入2012年8月至2019年9月于北京大学口腔医学院·口腔医院正畸科就诊的夜间呻吟症患者57例,其中男性22例、女性35例,年龄(31.1±10.9)岁,体重指数(21.7±2.7)kg/m2。所有患者经北京大学人民医院呼吸睡眠医学科整夜多导睡眠监测确诊,呻吟指数为4.8(1.8,13.0)次/h。其中10例患者合并阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)(夜间呻吟症合并OSAHS组),其余47例为单纯夜间呻吟症组。对全部患者进行鼻阻力测试,除1例孕早期患者外,对其余46例患者拍摄锥形束CT,对颅颌面、上气道及周围软组织进行头影测量,测量颅底倾斜度、下颌平面角、上中切牙-上牙槽座角、下中切牙-下颌平面角、软腭后气道径(软腭后-软腭后咽壁距)、喉咽气道径(会厌谷底-下咽壁距)等项目,并与课题组前期测量的正常参考值(来源于北京大学招募的144名正常大学生及于北京地区6所大学招募的100名无鼾症正常成人)进行比较。结果鼻压差150 Pa时57例夜间呻吟症患者鼻部吸气相总阻力值为(0.26±0.08)Pa·cm^(-3)·s^(-1)。夜间呻吟症患者总体上下颌硬组织发育良好:相比正常参考值,夜间呻吟症患者颅底倾斜度显著增大,下颌平面角显著减小,上中切牙-上牙槽座角和下中切牙-下颌平面角显著增大(P<0.05)。夜间呻吟症患者锥形束CT头颅侧位截面软腭后气道径[(19.2±4.5)mm]显著大于正常参考值(t=8.44,P<0.001),喉咽气道径[(17.4±6.4)mm]显著小于正常参考值(t=-2.79,P=0.006)。夜间呻吟症合并OSAHS组患者较单纯夜间呻吟症组表现为软腭和舌体更长、舌骨位置低下。结论夜间呻吟症患者颅颌面总体表现为颌骨矢状向发育良好、鼻阻力低,上下切牙唇倾;上气道上段Objective To analyze whether the upper airway of patients with catathrenia has obstructive manifestations using nasal resistance,craniofacial,and upper airway imaging methods,which could benefit the exploration of the etiology and treatment options.Methods From August 2012 to September 2019,a total of 57 patients with catathrenia in the Department of Orthodontics at Peking University Hospital of Stomatology were included in the study,including 22 males and 35 females,aged(31.1±10.9)years,with a body mass index of(21.7±2.7)kg/m2.All the patients were diagnosed by full-night polysomnography at the Sleep Division,Peking University People′s Hospital,of which 10 patients were combined with obstructive sleep apnea hypopnea syndrome(OSAHS).The median groaning index of patients was 4.8(1.8,13.0)events/h.Nasal resistance and cone-beam CT were conducted on the patients,and measurements were performed on the craniofacial structures,upper airway,and surrounding soft tissues,compared with non-snoring normal occlusion individuals′references published by the same research team(144 college students recruited at Peking University and 100 non-snoring young adults with normal occlusion recruited at six universities in Beijing).Results The total nasal resistance of patients with catathrenia was(0.26±0.08)Pa·cm^(-3)·s^(-1).The patients had overall well-developed mandibular hard tissues.However,the patients were found with increased FH/BaN(steep anterior cranial base plane),increased MP/FH(forward rotation of the mandible);increased U1/NA and L1/MP(proclined upper and lower incisors).The sagittal diameter of the velopharynx[(19.2±4.5)mm]was significantly larger than the normal reference(t=8.44,P<0.001),while the sagittal diameter at the hypopharynx[(17.4±6.4)mm]was statistically smaller than the normal reference(t=-2.79,P=0.006).Catarhrenia patients combined with OSAHS presented longer soft palate,tongue,and lower hyoid bone than those with primary catathrenia.Conclusions In patients with catathrenia,the overall craniofacia

关 键 词：锥束计算机体层摄影术 测颅法 气道阻力 睡眠呼吸暂停 阻塞性 夜间呻吟症 

分 类 号：R783.5[医药卫生—口腔医学]