【摘要】 目的研究阻塞型睡眠呼吸暂停低通气综合征与急性冠状动脉综合征患者冠状动脉病变严重程度及预后的相关性。方法将急性冠状动脉综合征患者根据冠状动脉造影结果和睡眠呼吸监测结果分为单纯急性冠状动脉综合征组及急性冠状动脉综合征合并轻度、中度和重度阻塞型睡眠呼吸暂停低通气综合征组,以Gensin i评分比较各组冠状动脉病变严重程度,并分析Gensin i评分与呼吸暂停低通气指数和夜间最低血氧饱和度的关系。6个月内对患者进行随访,比较各组间心血管联合终点事件发生情况。结果三个合并阻塞型睡眠呼吸暂停低通气综合征组呼吸暂停低通气指数明显高于单纯急性冠状动脉综合征组(P<0.01),而夜间最低血氧饱和度却明显低于单纯急性冠状动脉综合征组(P<0.01);合并中度和重度阻塞型睡眠呼吸暂停低通气综合征组呼吸暂停低通气指数明显高于轻度阻塞型睡眠呼吸暂停低通气综合征组(P<0.01),而夜间最低血氧饱和度则明显低于后者(P<0.01)。Gensin i评分合并中度和重度阻塞型睡眠呼吸暂停低通气综合征组明显高于另两组(P<0.01),且合并重度阻塞型睡眠呼吸暂停低通气综合征组的Gensin i评分明显高于中度阻塞型睡眠呼吸暂停低通气综合征组(P<0.05)。Gensin i评分与呼吸暂停低通气指数成正相关,Gensin i评分与夜间最低血氧饱和度成负相关。四组患者6个月内心血管联合终点事件发生率分别为19.35%、22.58%、32.26%和43.33%,重度阻塞型睡眠呼吸暂停低通气综合征组的心血管联合终点事件发生率显著高于单纯急性冠状动脉综合征组(P<0.05),其他各组间心血管联合终点事件差异无显著性(P>0.05)。血清总胆固醇、甘油三酯、低密度脂蛋白胆固醇、阻塞型睡眠呼吸暂停低通气综合征分级是急性冠状动脉综合征患者心血管联合终点事件发生的独立预测因子。结论中、重度阻塞型睡眠呼吸暂停低通气综合征可能是加重急性冠状动脉综合征患者冠状动脉病变严重程度的重要因素,阻塞型睡眠呼吸暂停低通气综合征会增加急性冠状动脉综合征近、中期预后的心血管联合终点事件发生率,尤其是重度阻塞型睡眠呼吸暂停低通气综合征对急性冠状动脉综合征患者的预后有显著影响,阻塞型睡眠呼吸暂停低通气综合征是急性冠状动脉综合征患者心血管联合终点事件的独立预测因子。更多还原

【Abstract】 Aim To investigate the correlation between severity of coronary artery lesions and middle-term prognosis with obstructive sleep apnea-hypopnea syndrome(OSAHS) in patients with acute coronary syndrome(ACS). Methods The patients with ACS were classified into four groups according to results of coronary angiography and polysomnography: ACS group(group Ⅰ),ACS complicated with mild OSAHS(group Ⅱ),ACS complicated with moderate OSAHS(group Ⅲ),ACS complicated with severe OSAHS(group Ⅳ).Coronary artery lesions’ severity was compared by Gensini score.The relationship between Gensini score and apnea hypopnea index(AHI) and nocturunal lowest blood oxygen saturation(LSaO2) were analyzed.The patients were followed up for six months,and the amounts of cardiovascular composite endpoint in four groups were compared. Results Compared with group Ⅰ,AHI of group Ⅱ,Ⅲ and Ⅳ were much higher(P<0.01),LSaO2 of group Ⅱ,Ⅲ and Ⅳ were much lower(P<0.01).Compared with group Ⅱ,AHI of group Ⅲ and Ⅳ were much higher(P<0.01),LSaO2 of group Ⅲ and Ⅳ were much lower(P<0.01).Compared with group Ⅱ and Ⅰ,Gensini scores of group Ⅲ and Ⅳ were much higher(P<0.01).Gensini score of group Ⅳ was higher than group Ⅲ(P<0.05).Gensini score was positively correlated with AHI and negatively with LSaO2.Incidence of cardiovascular composite endpoint events during six months in four groups were 19.35%,22.58%,32.26%,43.33% respectively.The group Ⅳ’s cardiovascular composite endpoint events was higher than group Ⅰ(P<0.05).Total cholesterol,triglyceride,low density lipoprotein cholesterol and classification of OSAHS were independent predictors for cardiovascular composite endpoint events. Conclusion Moderate and severe OSAHS is related to the severity of coronary artery lesions in patients with ACS.Complicated OSAHS in patients with ACS may increase the incidence rate of cardiovascular composite endpoint events,especially severe OSAHS.OSAHS is an independent predictor for cardiovascular composite endpoint events in patients with ACS.更多还原