Palm Andreas, Midgren Bengt, Janson Christer, Lindberg Eva
Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Box 256, Uppsala, SE-751 05, Sweden; Centre for Research and Development, Uppsala University, County Council of Gävleborg, Gävle Hospital, Gävle, SE-80188, Sweden.
Department of Respiratory Medicine, Lund University, Box 188, Lund, SE-221 00, Sweden.
Respir Med. 2016 Jan;110:73-8. doi: 10.1016/j.rmed.2015.11.010. Epub 2015 Nov 26.
Obesity hypoventilation syndrome (OHS) is often diagnosed late. The aim of this study was to analyse gender differences at initiation of long-term mechanical ventilation (LTMV) in patients with (OHS), to analyse gender differences in treatment effect and to study how the prescription of LTMV due to OHS has changed over time.
Data on patients on LTMV due to OHS between 1996 and 2014 were obtained from Swedevox, a nationwide health quality registry of patients on LTMV in Sweden.
When starting LTMV, women were generally older (age 64.4 ± 11.2 vs. 60.1 ± 12.1 years, p < 0.001), more obese (BMI 43.0 ± 8.2 vs. 41.5 ± 7.9 kg/m2, p < 0.001), more hypoxic (PaO2 7.6 ± 1.5 vs. 7.9 ± 1.6 kPa, p = 0.001), had more hypercapnia (PaCO2 7.2 ± 1.3 vs. 6.9 ± 1.3 kPa, p = 0.001), had higher base excess (6.9 ± 4.1 vs. 5.8 ± 4.7 kPa, p < 0.001) and more frequently started LTMV in a non-elective situation (43.2% vs. 37.5%, p = 0.026) than men. Improvement of arterial blood gas values or in age-adjusted mortality at one-year follow-up did not differ. During the study period, the age of patients at the initiation of LTMV rose by 3.4 years/decade (P = 0.001) in women and with 1.9 years/decade (P = 0.048) in men but there were no significant changes in BMI (P = 0.425).
Diagnosis of OHS is more delayed in women and as a consequence the disease is more advanced when diagnosed. In spite of this, there is no gender difference in survival rate in patients with OHS treated with LTMV. More and older patients with OHS nowadays gain access to LTMV.
肥胖低通气综合征（OHS）常被延迟诊断。本研究旨在分析OHS患者开始长期机械通气（LTMV）时的性别差异，分析治疗效果的性别差异，并研究因OHS进行LTMV治疗的处方随时间的变化情况。
1996年至2014年期间因OHS接受LTMV治疗的患者数据来自瑞典全国范围内的LTMV患者健康质量登记处Swedevox。
开始LTMV时，女性通常年龄更大（64.4±11.2岁 vs. 60.1±12.1岁，p<0.001）、更肥胖（BMI 43.0±8.2 vs. 41.5±7.9 kg/m2，p<0.001）、缺氧更严重（PaO2 7.6±1.5 vs. 7.9±1.6 kPa，p = 0.001）、高碳酸血症更严重（PaCO2 7.2±1.3 vs. 6.9±1.3 kPa，p = 0.001）、碱剩余更高（6.9±4.1 vs. 5.8±4.7 kPa，p<0.001），且与男性相比，女性更常在非择期情况下开始LTMV（43.2% vs. 37.5%，p = 0.026）。一年随访时动脉血气值的改善或年龄校正死亡率并无差异。在研究期间，女性开始LTMV时的年龄每十年上升3.4岁（P = 0.001），男性每十年上升1.9岁（P = 0.048），但BMI无显著变化（P = 0.425）。
OHS在女性中的诊断更延迟，因此确诊时疾病进展更严重。尽管如此，接受LTMV治疗的OHS患者生存率无性别差异。如今，更多且年龄更大的OHS患者能够接受LTMV治疗。
