中国呼吸与危重监护杂志

中国呼吸与危重监护杂志

阻塞性睡眠呼吸暂停低通气综合征血栓前状态危险因素分析

查看全文

目的 分析阻塞性睡眠呼吸暂停低通气综合征(OSAHS)血栓前状态的危险因素,为 OSAHS 患者静脉血栓栓塞症的预防提供参考和借鉴。 方法 选取 2014 年 6 月至 2016 年 7 月在新疆医科大学附属第一医院经多导睡眠监测(PSG)明确诊断为 OSHAS 并进行了凝血、血栓与纤溶检测及炎症因子组合测定,同时排除存在其他可能影响凝血功能因素的患者共 238 例。其中符合血栓前状态参考标准的患者 56 例(即血栓前状态组),剩余 182 例患者凝血及血栓与纤溶检测不满足参考标准,从中随机抽取 59 例患者为对照组(即非血栓前状态组)。比较两组患者年龄、性别、体重指数(BMI)、睡眠呼吸暂停低通气指数(AHI)、白细胞介素-6(IL-6)、合并慢性阻塞性肺疾病(简称慢阻肺)和合并高血压的状况。 结果 非条件 Logistic 回归分析显示 OSAHS 血栓前状态的危险因素有年龄(OR=1.202,95%CI:1.107~1.305)、IL-6(OR=1.127,95%CI:1.014~1.252)、AHI(OR=1.151,95%CI:1.055~1.256)、合并慢阻肺(OR=4.749,95%CI:1.046~21.555)。 结论 年龄、AHI、IL-6、合并慢阻肺可能是 OSAHS 患者血栓前状态的危险因素,其中合并慢阻肺可能是最重要的危险因素。

Objective To analyze the risk factors of prethrombotic state of obstructive sleep apnea and hyponea syndrome (OSAHS), providing basis and reference for the prevention of prethrombotic state of OSAHS. Methods Two hundred and thirty-eight patients excluding the presence of possible effects of coagulation factors from June 2014 to July 2016 were diagnosed as OSAHS by polysomnography (PSG) and underwent coagulation, thrombosis, fibrinolysis, and inflammatory factors testing. Fifty-six patients met the standard of prethrombotic state (prethrombotic state group) and 59 patients randomly selected from the remaining 182 patients did not meet the standard (non-prethrombotic state group). The age, sex, body mass index (BMI), sleep apnea and hypopnea index (AHI), interleukin-6 (IL-6), complicating chronic obstructive pulmonary disease (COPD) and hypertension were compared between two groups. Results Non conditional Logistic regression analysis showed that the risk factors of prethrombotic state of OSAHS were age (OR=1.202, 95%CI: 1.107 to 1.305), IL-6 (OR=1.127, 95%CI: 1.014 to 1.252), AHI (OR=1.151, 95%CI: 1.055 to 1.256), and complicating COPD (OR=4.749, 95%CI: 1.046 to 21.555). Conclusion Age, AHI, IL-6, and complicating COPD may be the risk factors of prethrombotic state of OSAHS, among which complicating COPD may be the most important risk factor.

关键词: 阻塞性睡眠呼吸暂停低通气综合征; 血栓前状态; 睡眠呼吸暂停低通气指数; 白细胞介素-6; 慢性阻塞性肺疾病

Key words: Obstructive sleep apnea and hyponea syndrome; Prethrombotic state; Sleep apnea and hypopnea index; Interleukin-6; Chronic obstructive pulmonary disease

引用本文: 黄斌, 杨增荣, 白桦, 黄毅, 何元兵. 阻塞性睡眠呼吸暂停低通气综合征血栓前状态危险因素分析. 中国呼吸与危重监护杂志, 2017, 16(5): 469-473. doi: 10.7507/1671-6205.201609043 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Peng Y H, Liao W C, Chung W S, et al. Association between obstructive sleep apnea and deep vein thrombosis/pulmonary embolism: A population-based retrospective cohort study. Thromb Res, 2014, 134(2): 340-345.
2. Alonso-Fernandez A, de la Pena M, Romero D, et al. Association between obstructive sleep apnea and pulmonary embolism. Mayo Clin Proc, 2013, 88(6): 579-587.
3. Lippi G, Mattiuzzi C, Franchini M. Sleep apnea and venous thromboembolism. A systematic review. Thromb Haemost, 2015, 114(5): 958-963.
4. 王鸿利. 实验诊断学. 第 2 版. 北京, 人民卫生出版社, 2010, 125-130.
5. 中华医学会呼吸病学分会睡眠呼吸障碍学组. 阻塞性睡眠呼吸暂停低通气综合征诊治指南 (2011 年修订版). 中华结核和呼吸杂志, 2012, 35(1): 9-12.0
6. 中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南 (2013 年修订版). 中华结核和呼吸杂志, 2013, 36(4): 255-264.0
7. McNicholas W T. Obstructive sleep apnea and inflammation. Prog Cardiovasc Dis, 2009, 51(5): 392-399.
8. Svensson M, Venge P, Janson C, et al. Relationship between sleep-disordered breathing and markers of systemic inflammation in women from the general population. J Sleep Res, 2012, 21(2): 147-154.
9. Maeder M T, Strobel W, Christ M, et al. Comprehensive biomarker profiling in patients with obstructive sleep apnea. Clin Biochem, 2015, 48(4-5): 340-346.
10. Shen P, Han Y, Cai B, et al. Decreased levels of serum nesfatin-1 in patients with obstructive sleep apnea syndrome. Sleep Breath, 2015, 19(2): 515-522.
11. Iturriaga R, Moya E A, Del Rio R. Inflammation and oxidative stress during intermittent hypoxia: The impact on chemoreception. Exp Physiol, 2015, 100(2): 149-155.
12. Passali D, Corallo G, Yaremchuk S, et al. Oxidative stress in patients with obstructive sleep apnoea syndrome. Acta Otorhinolaryngol Ital, 2015, 35(6): 420-425.
13. Ntalapascha M, Makris D, Kyparos A, et al. Oxidative stress in patients with obstructive sleep apnea syndrome. Sleep Breath, 2013, 17(2): 549-555.
14. 王辰, 陈荣昌. 呼吸病学. 第 2 版. 北京: 人民卫生出版社, 2014, 243-253.
15. Berghaus T M, Witkowska A, Wagner T, et al. Obstructive sleep apnea might trigger acute pulmonary embolism: Results from a cohort study. Clin Res Cardiol, 2016, 105(11): 938-943.
16. Alonso-Fernandez A, Garcia Suquia A, de la Pena M, et al. Obstructive sleep apnea is a risk factor for recurrent venous thromboembolism. Chest, 2016, 150(6): 1291-1301.
17. Alkhiary W, Morsy N E, Yousef A M, et al. Adenosine diphosphate-induced platelets aggregability in polysomnographically verified obstructive sleep apnea. Clin Appl Thromb Hemost, 2015, 22(15): 118-225.
18. Saghazadeh A, Rezaei N. Inflammation as a cause of venous thromboembolism. Crit Rev Oncol Hematol, 2016, 99(5): 272-285.
19. Borvik T, Braekkan S K, Enga K, et al. COPD and risk of venous thromboembolism and mortality in a general population. Eur Respir J, 2016, 47(2): 473-481.
20. Chen W J, Lin C C, Lin C Y, et al. Pulmonary embolism in chronic obstructive pulmonary disease: A population-based cohort study. Copd, 2014, 11(4): 438-443.
21. 陈临溪, 秦旭平, 黄秋林. 血管内皮细胞药理与临床. 北京: 人民军医出版社, 2012, 7-12.
22. Keenan C R, White R H. The effects of race/ethnicity and sex on the risk of venous thromboembolism. Curr Opin Pulm Med, 2007, 13(5): 377-383.
23. Karamanli H, Ozol D, Ugur K S, et al. Influence of CPAP treatment on airway and systemic inflammation in OSAS patients. Sleep Breath, 2014, 18(2): 251-256.
24. Wang Y, Su M, Zhang X. Effects of continuous positive airway pressure treatment of inflammatory factors in patients with overlap syndrome. Zhonghua Yi Xue Za Zhi, 2014, 94(6): 416-419.