睡眠呼吸障碍对颈动脉支架置入术后新发无症状缺血性脑损伤的预测价值研究  

Predictive value of sleep-disorder breathing for acute asymptomatic ischemic brain lesions after carotid artery stenting

作　　者：杨毅 申珅 万孟夏 张拥波[1] YANG Yi;SHEN Shen;WAN Mengxia;ZHANG Yongbo(Department of Neurology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院神经内科,100050

出　　处：《中国神经免疫学和神经病学杂志》2024年第6期436-440,共5页Chinese Journal of Neuroimmunology and Neurology

基　　金：国家自然科学基金资助项目(81671191)。

摘　　要：目的探讨睡眠呼吸障碍(sleep-disorder breathing,SDB)对颈动脉支架置入术(carotid artery sten-ting,CAS)后新发无症状缺血性脑损伤(new silent ischemic brain lesions,NSIBL)的预测价值。方法回顾性分析2018年10月至2022年12月首都医科大学附属北京友谊医院神经内科收治的76例行CAS患者的临床资料,根据术后是否发生NSIBL分为并发NSIBL组44例和未并发NSIBL(non-NSIBL)组32例,收集患者基线资料、影像学检查、睡眠呼吸暂停低通气指数(apnea-hypopnea index,AHI)等指标。采用多因素Logistic回归分析影响行CAS患者发生NSIBL的危险因素;绘制ROC曲线分析AHI对行CAS患者术后发生NSIBL的预测价值。结果(1)与non-NSIBL组相比,NSIBL组患者入院时收缩压、舒张压、AHI高(P<0.05);(2)多因素Logistic回归分析结果显示AHI是CAS术后发生NSIBL的独立影响因素(矫正OR=2.258,95%CI:1.529~3.344;P<0.01);(3)ROC曲线分析显示,AHI预测CAS后发生NSIBL的ROC曲线下面积(area under curve,AUC)为0.859(95%CI:0.775~0.943,P<0.01),cut-off值为20,其灵敏度84.1%,特异度78.1%。结论SDB是CAS后发生NSIBL的独立影响因素。Objective To investigate the predictive value of sleep-disorder breathing(SDB)for new silent ischemic brain lesions(NSIBL)after carotid artery stenting(CAS).Methods A retrospective study was conducted to analyze the clinical data of 76 patients with CAS,who admitted to the department of neurology,capital medical university afflicted Beijing friendship hospital from October 2018 to December 2022.The patients were divided into NSIBL group(44 cases)and non-NSIBL group(32 cases).General information,apnea-hypopnea index(AHI)and imaging findings were collected.The influencing factors of NSIBL in patients with CAS were analyzed by Logistic statistical analysis.ROC curve indicates the predictive value of AHI for CAS-NSIBL.Results(1)Systolic blood pressure,diastolic blood pressure on admission and AHI in NSIBL group were significantly higher than those in non-NSIBL group(P<0.05).(2)Multivariate Logistic regression analysis results showed that AHI(a OR=2.258,95%CI:1.529-3.344,P<0.01)was an independent influencing factor of CAS-NSIBL.(3)ROC curves demonstrated that the optimal cut off value of AHI index was 20(sensitivity 84.1%,specificity 78.1%),the area under the curve(AUC)value was 0.859(95%CI:0.775-0.943,P<0.01).Conclusions SDB is an independent influencing factors for new silent ischemic brain lesions after CAS.

关 键 词：颈动脉支架置入术 新发无症状缺血性脑损伤 呼吸暂停低通气指数 动脉粥样硬化 

分 类 号：R743.1[医药卫生—神经病学与精神病学]