矽肺患者合并阻塞性睡眠呼吸暂停低通气综合征的临床特征分析  

Analysis on clinical characteristic in silicosis patients with obstructive sleep apnea-hypopnea syndrome

作　　者：贺今 王贝贝[1] 邱梦茹[1] 王丽[1] 刘保岩 刘燕[1] HE Jin;WANG Beibei;QIU Mengru;WANG Li;LIU Baoyan;LIU Yan(Shandong Academy of Occupational Health and Occupational Medicine(Occupational Disease Hospital of Shandong First Medical University&Shandong Province Hospital of Occupational Disease),Jinan,Shandong 250062,China)

机构地区：[1]山东省职业卫生与职业病防治研究院(山东第一医科大学附属职业病医院,山东省职业病医院),山东济南250062

出　　处：《职业与健康》2024年第15期2017-2020,共4页Occupation and Health

基　　金：山东省自然科学基金(ZR2021MH178);山东省中医药科技项目(2021Q082);山东第一医科大学学术提升计划(2019QL001)。

摘　　要：目的探讨矽肺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)夜间低氧血症发生情况等临床特征。方法回顾性分析山东省职业卫生与职业病防治研究院2022年1—12月住院治疗的经多导睡眠呼吸记录监测检查后确诊OSAHS患者,纳入矽肺患者合并OSAHS的65例为病例组,包括壹期30例、贰期15例、叁期20例3组。同时选择10例不接尘的单纯OSAHS患者作为对照组,观察3组矽肺患者与对照组的Epworth嗜睡量表(Epworth sleepiness scale,ESS)评分、体质量指数(body mass index,BMI)、呼吸暂停低通气指数(apnea-hypopnea index,AHI)、最低血氧饱和度(low oxygen saturation of blood,Low SPO_(2))、SPO_(2)低于90%的时间(time of sleep with oxygen saturation under 90%,T90)、阻塞性呼吸暂停低通气指数(obstructive apnea index,OAI)、肺功能及呼出气一氧化氮(fractional exhaled nitric oxide,FENO)等指标变化,分析3组患者与对照组的临床资料特征。结果与对照组相比,矽肺贰期合并OSAHS患者的AHI[(22.03±6.59)次/h]显著增高、Low SPO_(2)[(78.27±9.54)%]显著降低(均P<0.05);矽肺贰期T90[(14.25±8.53)min]、低通气指数[(11.45±5.18)次/h]和叁期T90[(17.09±9.05)min]、低通气指数[(8.85±3.98)次/h]均显著增高(均P<0.01);病例组3组间比较,与矽肺壹期相比,贰期、叁期AHI、T90均显著增高,且AHI在贰期显著高于叁期患者(均P<0.05),贰期OAI、AHI均显著增高(均P<0.05)。结论矽肺患者合并OSAHS夜间低氧血症的发生率较不接尘的单纯OSAHS患者增高。Objective To explore the clinical characteristics such as hypoxemia in silicosis patients with obstructive sleep apneahypopnea syndrome(OSAHS).Methods A retrospective analysis was conducted on 65 cases of silicosis with OSAHS diagnosed by overnight polysomnography(PSG)admitted in Shandong Provincial Hospital of Occupational Disease from January to December 2022.A total of 65 silicosis patients with OSAHS were included in the case group,including three groups:PhaseⅠ(30 cases),PhaseⅡ(15 cases),and PhaseⅢ(20 cases).At the same time,10 simple OSAHS patients who were not exposed to dust were selected as the control group.The clinical statistics analysis on the characteristics of patients in theⅠ,ⅡandⅢstages of silicosis with OSAHS and the control group were assessed by Epworth sleepiness scale score(ESS),body mass index(BMI),apneahypopnea index(AHI),low oxygen saturation of blood(Low SPO_(2)),time of sleep with oxygen saturation under 90%(T90),obstructive apnea index(OAI)and fractional exhaled nitric oxide(FENO),etc.indexes.Results Compared to the control group,the levels of AHI[(22.03±6.59)times/h]were increased significantly and Low SPO_(2)[(78.27±9.54)%]decreased significantly in silicosis patients in stageⅡcomplicated with OSAHS(both P<0.05),the level of T90[(14.25±8.53)min],hypopnea index[(11.45±5.18)times/h]were increased significantly in silicosis patients in stageⅡ,and T90[(17.09±9.05)min]and hypopnea index[(8.85±3.98)times/h]were increased significantly in silicosis patients in stageⅢ(all P<0.01).Compared with stageⅠsilicosis,the AHI and T90 in stageⅡand stageⅢof the case group were significantly increased,and the AHI in stageⅡwas significantly higher than that in stageⅢpatients(all P<0.05).The OAI and AHI in stageⅡwere significantly increased than those in stageⅠ(all P<0.05).Conclusion The incidence of nocturnal hypoxemia in patients with silicosis combined with obstructive sleep apnea(OSAHS)is higher than that in simple OSAHS patients who are not exposed to dust.

关 键 词：睡眠呼吸暂停低通气综合征 矽肺 临床特征 低氧血症 

分 类 号：R135.2[医药卫生—劳动卫生]