咽容积联合鼻腔最小截面积在成人非肥胖型OSAHS早期筛查中的应用价值  

Application of pharyngeal volume combined with minimal nasal cross-sectional area in early screening of adult non-obese obstructive sleep apnea hypopnea syndrome

作　　者：方勇进 杜欢乐[1] 黄宏伟[2] 林诗映 FANG Yongjin;DU Huanle;HUANG Hongwei;LIN Shiying(Department of Otolaryngology Head and Neck Surgery,Jinhua Municipal Centeral Hospital,Jinhua 321000,China)

机构地区：[1]金华市中心医院耳鼻喉头颈外科,321000 [2]金华市中心医院医学影像科,321000 [3]金华市中心医院电生理科,321000

出　　处：《浙江医学》2024年第2期162-166,171,共6页Zhejiang Medical Journal

基　　金：金华市重大(重点)科学技术研究计划项目(2021-3-137)。

摘　　要：目的探讨咽容积联合鼻腔最小截面积(mCSA)在成人非肥胖型阻塞性睡眠呼吸暂停低通气综合征(OSAHS)早期筛查中的应用价值。方法选取2023年1至6月在金华市中心医院经多导睡眠监测(PSG)确诊OSAHS的成人非肥胖型患者75例为观察组,选取同期性别、年龄和BMI相匹配的健康志愿者50名为对照组。采用256层螺旋CT及后重建技术测量平静呼吸和Muller呼吸时相的咽腔参数(包括腭咽腔与舌咽腔的最小截面积和容积)和mCSA。比较两组患者的临床资料、咽腔参数和mCSA,采用Spearman秩相关分析咽腔参数和mCSA与PSG参数的相关性。ROC曲线评估舌咽腔容积和mCSA单独和联合诊断成人非肥胖型OSAHS的效能。结果观察组患者鼻炎比例、高血压比例和ESS评分均高于对照组,差异均有统计学意义(均P<0.01)。观察组患者Muller呼吸时相的腭咽腔与舌咽腔的最小截面积和容积以及mCSA均小于对照组,差异均有统计学意义(均P<0.01)。Spearman秩相关分析显示,观察组患者Muller呼吸时相的舌咽腔容积和mCSA与呼吸暂停低通气指数和最低动脉血氧饱和度均呈负相关(均P<0.05),而与血氧饱和度低于90%的时间百分比均呈正相关(均P<0.01)。ROC曲线显示,Muller呼吸时相的舌咽腔容积、mCSA及两者联合诊断成人非肥胖型OSAHS的AUC分别为0.831、0.743和0.878,两者联合诊断高于单一指标(均P<0.01)。结论CT测量咽容积和mCSA可作为早期筛查诊断成人非肥胖型OSAHS的无创性指标,联合诊断有较好的应用潜能。Objective To explore the application value of pharyngeal volume combined with minimal nasal crosssectional area(mCSA)in early screening of adult non-obese obstructive sleep apnea hypopnea syndrome(OSAHS).Methods Seventy-five adult non-obese patients with OSAHS diagnosed by polysomnography(PSG)in Jinhua Municipal Centeral Hospital from January to June 2023 were selected as the observation group,while 50 healthy volunteers matched in gender,age,and BMI were selected as the control group.The pharyngeal parameters(including minimal cross-sectional area and volume of palatopharyngeal and glossopharyngeal cavities)and mCSA during calm breathing and Muller breathing were examined by using 256 slice spiral CT and post reconstruction technology.The clinical data,pharyngeal parameters,and mCSA were compared between the two groups,and Spearman analysis was used to examine the correlation between pharyngeal parameters,mCSA,and PSG parameters.ROC curve was used to evaluate the efficacy of glossopharyngeal volume and mCSA alone or in combination in diagnosis of adult non-obese OSAHS.Results The proportions of rhinitis and hypertension,and Epworth sleepiness scale(ESS)score in the observation group were higher than those of the control group(all P<0.01).The minimal cross-sectional area and volume of the palatopharyngeal and glossopharyngeal cavities,as well as mCSA value during Muller breathing in the observation group were significantly less than the control group(all P<0.01).Spearman test showed that in the observation group,glossopharyngeal volume and mCSA values at Muller breathing phase were significantly negatively correlated with apnea hypopnea index and the lowest arterial oxygen saturation(all P<0.05),and were significantly positively correlated with the percentage of time when blood oxygen saturation was below 90%(both P<0.01).The receiver operating curve(ROC)showed that the area under the curve(AUC)of glossopharyngeal volume and mCSA values alone or in combination at Muller breathing phase for diagnosing adult non-ob

关 键 词：咽容积 鼻腔最小截面积 阻塞性睡眠呼吸暂停低通气综合征 多导睡眠监测 肥胖 

分 类 号：R766[医药卫生—耳鼻咽喉科]