【摘要】 目的探讨阻塞性睡眠呼吸暂停综合征(OSAS)患者左室几何构型与血浆同型半胱氨酸(Hcy)的相关性。方法选取我院确诊为OSAS的患者192例,依据左室质量指数(LVMI)和相对室壁厚度(RWT)将其按左室几何构型分为4组:正常构型组(NG组)82例、向心性重构组(CR组)47例、向心性肥厚组(CH组)34例、离心性肥厚组(EH组)29例,另选同期性别、年龄相匹配的正常健康成人30例为对照组,均行血压、血糖、血脂、血浆Hcy测定及超声心动图检查。比较各组上述测值的差异,采用单因素相关性分析血浆Hcy与一般资料、实验室指标及超声心动图参数的关系,并进一步行多元线性回归分析。结果各组体质量指数、腹围、收缩压,以及室间隔厚度(IVSd)、左室后壁厚度(LVPWd)、左室舒张末期内径(LVEDd)、二尖瓣环舒张早期与舒张晚期峰值流速比值(Em/Am)、LVMI、RWT比较,差异均有统计学意义(均P<0.05)。CR组、CH组、EH组IVSd、LVPWd均较对照组、NG组增高;NG组、CR组、CH组、EH组Em/Am均较对照组减低,CR组、CH组、EH组LVEDd、RWT均较NG组增加;CH组、EH组LVMI均较对照组、NG组、CR组增加,差异均有统计学意义(均P<0.05)。CR组、EH组血浆Hcy水平均高于对照组、NG组、CR组,EH组高于对照组,差异均有统计学意义(均P<0.05)。单因素相关性分析显示:血浆Hcy与体质量指数、收缩压、腹围、呼吸暂停低通气指数(AHI)、血糖、LVMI、左室几何构型、OSAS严重程度均呈正相关(r=0.277、0.253、0.249、0.233、0.184、0.418、0.461、0.163,均P<0.05),与Em/Am、左室射血分数均呈负相关(r=-0.248、-0.138,均P<0.05)。多元线性回归分析显示:血浆Hcy与AHI、LVMI、异常左室几何构型、OSAS严重程度均独立相关(t=3.327、2.780、2.268、2.299,P=0.003、0.007、0.045、0.023)。结论 OSAS患者左室几何构型与血浆Hcy相关,血浆Hcy是OSAS患者左室CH改变的主要影响因素之一。更多还原

【Abstract】 Objective plasma homocysteine in patients with obstructive sleep apnea syndrome(OSAS).Methods OSAS in our hospital were selected.Patients with OSAS were divided into 4 groups according to geometric configuration based on LV mass index(LVMI)and relative ventricular wall thickness(RWT):normal configuration group(NG group,n=82),centripetal remodeling group(CR group,n=47),centripetal hypertrophy group(CH group,n=34),and centrifugal hypertrophy group(EH group,n=29).In addition,30 normal healthy adults with matching gender and age were selected as the control group.The blood pressure,blood glucose,blood lipids,and plasma homocysteine levels were measured,and echocardiography was performed.The difference of above parameters among the control group and the four OSAS groups were compared,the correlation between plasma homocysteine and general data,laboratory biochemical indicators and echocardiographic parameters was analyzed by univariate correlation analysis,and the multivariate stepwise linear regression analysis was further performed.Results were significant differences of the body mass index,abdominal circumference,systolic blood pressure,and ventricular septal thickness(IVSd),left ventricular posterior wall thickness(LVPWd),left ventricular end diastolic diameter(LVEDD),the ratio of peak flow velocity in early diastole to peak flow velocity in late diastole(Em/Am)of mitral valve annulus,LVMI,and RWT in each group(all P<0.05).IVSd and LVPWd of CR group,CH group,EH group were higher than those of control group and NG group,Em/Am of NG group,CR group,CH group,EH group was lower than that of control group,the LVEDD and RWT of CR group,CH group,and EH group were increased compared with NG group,LVMI of CH group and EH group were increased compared with control group,NG group,CR group,the difference were statistically significant(all P<0.05). The plasma homocysteine levels of CR group and EH group was higher than that of control group,NG group,CR group,and EH group was higher than control group,the difference were statistically significant(all P<0.05).Univariate correlation analysis showed that plasma homocysteine was positively correlated with body mass index,systolic blood pressure,abdominal circumference,sleep apnea hypopnea index(AHI),blood glucose,LVMI,left ventricular geometrical configuration,and OSAS severity(r=0.277,0.253,0.249,0.233,0.184,0.418,0.461,0.163,all P<0.05),and plasma homocysteine was negatively correlated with Em/Am and LVEF(r=-0.248,-0.138,both P<0.05). Multivariate stepwise linear regression analysis of showed that plasma homocysteine was independently related to AHI,LVMI,abnormal left ventricular geometrical configuration,and OSAS severity(t=3.327,2.780,2.268,2.299,P=0.003,0.007,0.045,0.023).Conclusion geometrical configuration and plasma homocysteine in OSAS patients,and plasma homocysteine is one of the main influencing factors of altered left ventricular CH and EH in OSAS patients.更多还原