超声极速脉搏波技术评估中重度阻塞性睡眠呼吸暂停患者CPAP治疗前后颈动脉弹性的变化

孙雪婷; 孙志丹; 冯艳红

doi:10.13201/j.issn.2096-7993.2021.08.008

超声极速脉搏波技术评估中重度阻塞性睡眠呼吸暂停患者CPAP治疗前后颈动脉弹性的变化

- 锦州医科大学附属第一医院超声科(辽宁锦州，121000)
基金项目:
辽宁省自然科学基金计划重点项目(No：20180530009)

详细信息

通讯作者: 孙志丹，E-mail：szdpost@sina.com

中图分类号: R766

收稿日期: 2021-05-13

刊出日期: 2021-08-05

Changes of carotid artery elasticity before and after CPAP in patients with obstructive sleep apnea by ultrasonic ultrafast pulse wave velocity technique

- Department of Ultrasound, the First Affiliated Hospital of Jinzhou Medical University, Jinzhou, 121000, China

More Information

Corresponding author: SUN Zhidan, E-mail: szdpost@sina.com

Received Date: 13 May 2021

Publish Date: 05 August 2021

摘要

摘要: 目的应用超声极速脉搏波(UFPWV)技术检测阻塞性睡眠呼吸暂停(OSA)患者在持续气道正压通气(CPAP)治疗前后的颈动脉弹性变化，并探究OSA患者动脉弹性的影响因素，为临床防治心血管并发症提供指导。方法收集2020年1月—2020年12月接受PSG监测后确诊的中重度OSA患者50例作为OSA组，同时期选取参加体检且与OSA组年龄和性别等匹配的40例健康者为对照组。对OSA组进行12周CPAP治疗。记录对照组、OSA组治疗前及治疗后的临床指标、颈动脉内-中膜厚度(IMT)、收缩期开始时脉搏波传播速度(PWVBS)和收缩期结束时脉搏波传播速度(PWVES)。比较对照组和OSA组、OSA组治疗前和治疗后各项指标的变化，并分析PWVBS和PWVES的相关因素和影响因素。结果治疗前OSA组的血脂指标、收缩压、IMT、PWVBS和PWVES高于对照组(P < 0.05)；OSA组CPAP治疗后和治疗前比较：PWVBS、PWVES、呼吸暂停低通气指数(AHI)、血氧饱和度(SaO₂) < 90%时间、SaO₂ < 90%时间占监测时间百分比(T90)、低密度脂蛋白胆固醇(LDL-C)和三酰甘油(TG)降低(P < 0.05)，最低血氧饱和度(LSaO₂)、高密度脂蛋白胆固醇(HDL-C)升高(P < 0.05)；年龄、收缩压、IMT、AHI、T90、SaO₂ < 90%时间与PWVBS和PWVES呈正相关，HDL-C、LSaO₂与之呈负相关(P < 0.05)；PWVBS和PWVES的危险因素有收缩压、AHI、TC、T90。结论中重度OSA能造成动脉弹性降低；CPAP治疗可改善OSA患者颈动脉弹性功能；UFPWV技术定量评估OSA患者动脉弹性变化比传统二维超声更敏感。
- 睡眠呼吸暂停，阻塞性 /
- 超声极速脉搏波技术 /
- 颈动脉弹性 /
- 持续气道正压通气
Abstract: Objective To examine the changes of carotid artery elasticity in patients with obstructive sleep apnea(OSA) before and after continuous positive airway pressure(CPAP) treatment by ultrafast pulse wave velocity(UFPWV) technique, and to explore the influencing factors of carotid artery elasticity in OSA patients, and to provide guidance for clinical prevention and treatment of cardiovascular complications.Methods Fifty cases of moderate and severe OSA patients diagnosed with PSG monitoring from January 2020 to December 2020 were collected as the OSA group, at the same time, 40 healthy subjects who participated in physical examination and matched with OSA group in age and gender were selected as the control group.The OSA group was treated with CPAP for 12 weeks.Clinical indicators, carotid intima-media thickness(IMT), and pulse wave velocity at the beginning of systole(PWVBS) and pulse wave velocity at the end of systole(PWVES) were recorded in the control group, and the above data were collected in the OSA group before and after treatment.The changes of various indicators between the control group and the OSA group, and between the OSA group before and after treatment were compared.The correlative factors and influencing factors of PWVBS and PWVES are analyzed.Results The serum lipid indexes, IMT, PWVBS and PWVES in OSA group were higher than those in control group(P < 0.05).Comparison between post-treatment and pre-treatment with CPAP in OSA group: PWVBS, PWVES, apnea hypopnea index(AHI), blood oxygen saturation(SaO₂) less than 90% of the time, the percentage of monitoring time when SaO₂ was less than 90%(T90), low density lipoprotein cholesterol(LDL-C)and triglyceride(TG) were decreased(P < 0.05).Lowest blood oxygen saturation(LSaO₂) and high density lipoprotein cholesterol(HDL-C) increased(P < 0.05).Age, systolic blood pressure, IMT, AHI, T90 and time of oxygen saturation below 90% were positively correlated with PWVBS and PWVES, while HDL-C and LSaO₂ were negatively correlated with them(P < 0.05).The risk factors of PWVBS and PWVES included systolic blood pressure, AHI, TC, T90.Conclusion Moderate and severe OSA can reduce arterial elasticity.CPAP can improve carotid artery elasticity function in patients with OSA.UFPWV technique is more sensitive to quantitatively evaluate the changes of arterial elasticity in patients with OSA than traditional two-dimensional ultrasound.
- sleep apnea, obstructive /
- ultrasonic ultrafast pulse wave velocity technique /
- carotid artery elasticity /
- continuous positive airway pressure

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图 1 同一重度OSA患者CPAP治疗前后动脉弹性变化的UFPWV测值

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表 1 对照组和OSA组治疗前的一般资料及超声结果比较

指标	OSA组	对照组	t/χ²	P
年龄/岁	51.44±8.95	53.20±7.49	0.904	0.369
性别(男/女)	35/15	27/13	0.065	0.799
PWVBS/(m·s^-1)	7.54±0.79	6.34±0.77	-6.681	0.000
PWVES/(m·s^-1)	9.24±0.87	8.10±0.75	-5.862	0.000
IMT/mm	0.78±0.18	0.63±0.11	-4.190	0.000
AHI/(次·h^-1)	38.58±11.54	1.80±0.77	-17.389	0.000
SaO₂ < 90%时间/min	28.49±8.30	1.10±0.85	-17.975	0.000
T90/%	6.78±1.96	0.26±0.20	-17.971	0.000
LSaO₂/%	72.34±8.16	93.91±0.59	13.818	0.000
BMI/(kg·m^-2)	27.21±2.41	26.33±1.51	-1.788	0.078
舒张压/mmHg	74.66±7.24	74.00±4.66	-0.645	0.521
收缩压/mmHg	125.46±3.11	122.03±3.60	-4.502	0.000
FBG/(mmol·L^-1)	4.93±0.26	4.91±0.25	-0.341	0.734
LDL-C/(mmol·L^-1)	3.25±0.15	3.29±0.14	0.945	0.348
HDL-C/(mmol·L^-1)	1.20±0.09	1.39±0.08	9.287	0.000
TG/(mmol·L^-1)	1.87±0.14	1.66±0.16	-6.133	0.000
TC/(mmol·L^-1)	5.12±0.29	5.10±0.27	-0.300	0.765
心率/(次·min^-1)	74.54±7.24	74.00±4.66	-0.686	0.495
注：1 mmHg=0.133 kPa。

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表 2 OSA组治疗前后的各指标比较(n=50)

指标	治疗前	治疗后	t	P
PWVBS/(m·s^-1)	7.54±0.79	6.86±0.91	8.282	0.000
PWVES/(m·s^-1)	9.24±0.87	8.42±1.18	8.075	0.000
IMT/mm	0.78±0.18	0.77±0.18	1.358	0.181
AHI/(次·h^-1)	38.58±11.54	6.52±3.51	24.601	0.000
SaO₂ < 90%时间/min	28.49±8.30	3.38±1.74	26.475	0.000
T90/%	6.78±1.96	0.81±0.42	26.469	0.000
LSaO₂/%	72.34±8.16	85.56±7.28	-27.503	0.000
BMI/(kg·m^-2)	27.21±2.41	27.02±2.25	1.405	0.166
舒张压/mmHg	74.66±7.24	74.60±3.73	0.067	0.946
收缩压/mmHg	125.46±3.11	124.60±3.18	1.514	0.136
FBG/(mmol·L^-1)	4.93±0.26	4.89±0.29	1.156	0.253
LDL-C/(mmol·L^-1)	3.25±0.15	3.21±0.16	2.415	0.020
HDL-C/(mmol·L^-1)	1.20±0.09	1.28±0.09	-8.090	0.000
TG/(mmol·L^-1)	1.87±0.14	1.81±0.13	2.089	0.042
TC/(mmol·L^-1)	5.12±0.29	5.14±0.28	-0.331	0.742
心率/(次·min^-1)	74.54±7.24	73.88±7.01	1.394	0.170

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表 3 PWVBS、PWVES与各指标的相关性分析(n=50)

指标	PWVBS		PWVES
指标	r	P	r	P
年龄/岁	0.500	0.000	0.486	0.000
AHI/(次·h^-1)	0.562	0.000	0.523	0.000
SaO₂ < 90%时间/min	0.459	0.001	0.421	0.002
T90/%	0.458	0.000	0.420	0.001
LSaO₂/%	-0.484	0.000	-0.470	0.001
收缩压/mmHg	0.643	0.000	0.660	0.000
HDL-C/(mmol·L^-1)	-0.360	0.010	-0.372	0.008
TG/(mmol·L^-1)	0.610	0.000	0.604	0.000
TC/(mmol·L^-1)	0.636	0.000	0.635	0.000
IMT/mm	0.666	0.000	0.732	0.000
心率/(次·min^-1)	-0.103	0.478	-0.110	0.449
BMI/(kg·m^-2)	0.185	0.197	0.157	0.276
性别(男/女)	-0.116	0.424	-0.064	0.659
舒张压/mmHg	0.128	0.375	0.080	0.582
FBG/(mmol·L^-1)	0.098	0.499	0.150	0.299
LDL-C/(mmol·L^-1)	0.174	0.227	0.139	0.334

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表 4 PWVBS、PWVES与各因素的多元逐步回归分析(n=50)

因素	PWVBS		PWVES
因素	标准化系数β	P	标准化系数β	P
AHI/(次·h^-1)	1.274	0.001	1.213	0.001
收缩压/mmHg	0.314	0.005	0.347	0.003
T90/%	-0.996	0.005	-0.987	0.006
TC/(mmol·L^-1)	0.319	0.006	0.324	0.006

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