急性缺血性脑卒中伴OSAHS患者中医证型与睡眠监测指标的相关性分析  

Correlation analysis between traditional Chinese medicine syndromes and sleep monitoring indexes in acute ischemic stroke patients with OSAHS

作　　者：许黎敏 王倩 徐惠 焦雯玥 叶青[1] 袁灿兴[1] 王秀薇[1] XU Limin;WANG Qian;XU Hui;JIAO Wenyue;YE Qing;YUAN Canxing;WANG Xiuwei(Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China;Baoding Sixth Hospital,Baoding,Hebei 071000,China)

机构地区：[1]上海中医药大学附属龙华医院,上海200032 [2]河北省保定市第六医院,河北保定071000

出　　处：《上海中医药杂志》2024年第9期40-44,共5页Shanghai Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(82074355);上海市卫健委科研课题(20204Y0168);上海市中医神志病研究所开放课题(SZB2022101);上海市科委医学创新研究专项重大项目(21Y31920300);上海申康医院发展中心研究型医师创新转化能力培训项目(SHDC2023CRD005)。

摘　　要：目的探讨急性缺血性脑卒中(AIS)伴阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者中医证型与睡眠监测指标的相关性。方法根据睡眠呼吸监测结果将145例AIS患者分为伴OSAHS组(81例)、不伴OSAHS组(64例),比较两组性别、年龄、体质量指数(BMI)、颈围、胸围、腰围、美国国立卫生研究院卒中量表(NIHSS)评分的差异;收集中医证候信息,并进行中医辨证分型,比较不同严重程度、不同中医证型AIS患者的呼吸暂停低通气指数(AHI)和最低末梢指脉氧(LSpO2)水平;采用二元logistics回归分析法分析中医证型与睡眠监测指标的相关性。结果①两组BMI、胸围、腰围差异有统计学意义(P<0.05)。②伴OSAHS组以风痰瘀阻证多见(43.2%),不伴OSAHS组以风火上扰证多见(31.3%);两组中医证型分布情况比较,差异有统计学意义(P<0.05)。③伴OSAHS组患者的NIHSS评分高于不伴OSAHS组(P<0.05)。④145例AIS患者中,轻型90例、非轻型55例。轻型AIS患者LSpO2值高于非轻型AIS患者(P<0.05);两组AHI值比较,差异无统计学意义(P>0.05)。⑤不同证型AIS患者AHI、LSpO2值差异有统计学意义(H=27.614,P<0.05;H=20.939,P<0.05)。进一步两两比较,风痰瘀阻证患者AHI值最高、LSpO2值最低(P<0.05)。⑥二元logistic回归分析显示,OSAHS病情严重程度[OR=0.635,95%CI(0.419~0.962),P<0.05]是预测风火上扰证的独立影响因素,性别[OR=3.986,95%CI(1.178~13.488),P<0.05]、AHI[OR=1.090,95%CI(1.046~1.136),P<0.05]、OSAHS病情严重程度[OR=3.162,95%CI(2.073~4.824),P<0.05]是预测风痰瘀阻证的独立影响因素,性别[OR=0.225,95%CI(0.060~0.850),P<0.05]、BMI[OR=1.170,95%CI(1.025~1.335),P<0.05]是预测气虚血瘀证的独立影响因素,AHI[OR=0.907,95%CI(0.826~0.996),P<0.05]是预测阴虚风动证的独立影响因素。结论AIS伴OSAHS患者中风痰瘀阻证最为常见,此类患者AHI更高,夜间低血氧程度更重;性别、BMI、AHI、OSAHS病情严重程度与AIS伴OSAHS患者的中医辨证分�Objective To explore the correlation between traditional Chinese medicine(TCM)syndromes and sleep monitoring indexes in patients Methods results,145 AIS patients were divided into two groups:those with OSAHS(n=81)and those without OSAHS(n=64).We compared differences in gender,age,body mass index(BMI),neck,chest,and waist circumferences,and national institutes of health stroke scale(NIHSS)scores.TCM syndromes were documented and analyzed through TCM syndrome differentiation.Apnea-hypopnea index(AHI)and lowest oxygen saturation(LSpO2)values were compared across different severities and TCM syndromes.Binary logistic regression was used to assess the correlation between TCM syndromes and sleep monitoring indexes.Results①There were statistically significant differences in BMI,chest,and waist circumferences between the two groups(P<0.05).②The OSAHS group primarily presented with blockade of wind-phlegm-static blood syndrome(43.2%),whereas the non-OSAHS group showed upward disturbance of wind-fire syndrome(31.3%).The distribution of TCM syndromes between the two groups showed statistically significant differences(P<0.05).③Patients in the OSAHS group had higher NIHSS scores than those in the non-OSAHS group(P<0.05).④Of the 145 AIS patients,90 were classified as mild and 55 as non-mild.Mild AIS patients showed higher LSpO2 values than non-mild AIS patients(P<0.05).However,there were no statistically significant differences in AHI values between the two groups(P>0.05).⑤Significant differences were observed in AHI and LSpO2 values among AIS patients with different TCM syndromes(H=27.614,P<0.05;H=20.939,P<0.05).Further pairwise comparisons revealed that patients with blockade of wind-phlegm-static blood syndrome had the highest AHI values and the lowest LSpO2 values(P<0.05).⑥Binary logistic regression analysis indicated that the severity of OSAHS[OR=0.635,95%CI(0.419~0.962),P<0.05]was an independent predictor for the upward disturbance of wind-fire syndrome.Gender[OR=3.986,95%CI(1.178~13.488),P<0.05],AHI[OR=1.090

关 键 词：急性缺血性脑卒中 脑梗死 阻塞性睡眠呼吸暂停低通气综合征 中医证型 相关性分析 

分 类 号：R277.7[医药卫生—中医学]