[阻塞性睡眠呼吸暂停对慢性阻塞性肺疾病患者心肺功能的影响]
[Effect of obstructive sleep apnea on cardiopulmonary function in patients with chronic obstructive pulmonary disease].
作者信息
Shen J C, Sun L, Wang J, Du Z Y, Chen R
机构信息
Department of Respiratory and Critical Medicine, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China.
Department of Respiratory and Critical Medicine, the Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu 322000, China.
出版信息
Zhonghua Yi Xue Za Zhi. 2021 Jun 15;101(22):1665-1670. doi: 10.3760/cma.j.cn112137-20201125-03187.
To study the characteristics of cardiopulmonary function in patients with chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) overlapping syndrome (OS). A total of 149 COPD patients, who were on stable treatment, were enrolled from the Second Affiliated Hospital of Soochow University from December 2017 to December 2019. The patients were divided into the OS group (=56) and the COPD only group (=93) according to their apnea hypopnea index (AHI) measured by the Apnealink device. Data were gathered from polysomnograph (PSG), spirometry, arterial blood gas and N-terminal pro-brain natriuretic peptide (NT-proBNP) assay to assess the cardiopulmonary function of patients. Partial correlation analysis was used to analyze the correlation between AHI and various factors, to study the characteristic changes in the cardiopulmonary function of these OS patients. There were no significant cross-group differences in age and gender (all >0.05). In the OS group, the forced expiratory volume in one second to forced vital capacity ratio (FEV/FVC), the forced expiratory volume in the first second expressed as percent predicted (FEV%pred), pH[ (, )], partial pressure of oxygen (PaO) and oxygen saturation (SaO) were lower than those in the COPD group [(49.46±12.98)% vs (54.38±11.72)%, (47.86±14.78)% vs (57.78±15.81)%, 7.37(7.34, 7.39) vs 7.40(7.39, 7.41), (80.75±10.20) vs (84.28±8.43) mmHg (1 mmHg=0.133 kPa), (94.46±2.52)% vs (95.74±2.28)%], whereas partial pressure of carbon dioxide (PaCO) [ (, )] was higher than that in the COPD group [55.00 (45.50, 60.00) vs 44.00(40.00, 48.00)mmHg] (all <0.05). Pulmonary arterial pressure and plasma NT-proBNP levels [ (, )] in the OS group were significantly higher than those in the COPD group [38.90 (28.60, 49.05) vs 28.60 (24.95, 32.60) mmHg, 434.00 (273.75, 631.00) vs 136.00 (86.00, 205.00) pg/ml] (<0.05). Partial correlation analysis showed that AHI was positively correlated with PaCO, pulmonary artery pressure, NT-proBNP, and acute exacerbation events ( values: 0.496, 0.544, 0.628, 0.446), and negatively correlated with FEV/FVC, FEV%pred, pH, PaO, and SaO ( values:-0.309, -0.346, -0.410, -0.289, -0.267) (all <0.05). Patients with OS suffer from more severe hypoxemia, hypercapnia and pulmonary function damage, and their pulmonary arterial pressure and NT-proBNP are significantly higher than those with COPD only.
研究慢性阻塞性肺疾病（COPD）合并阻塞性睡眠呼吸暂停（OSA）重叠综合征（OS）患者的心肺功能特征。2017年12月至2019年12月，从苏州大学附属第二医院招募了149例病情稳定的COPD患者。根据通过Apnealink设备测量的呼吸暂停低通气指数（AHI），将患者分为OS组（n = 56）和单纯COPD组（n = 93）。收集多导睡眠图（PSG）、肺功能仪、动脉血气和N末端脑钠肽前体（NT-proBNP）检测的数据，以评估患者的心肺功能。采用偏相关分析来分析AHI与各种因素之间的相关性，以研究这些OS患者心肺功能的特征性变化。两组在年龄和性别方面无显著差异（均P>0.05）。OS组的一秒用力呼气容积与用力肺活量比值（FEV₁/FVC）、第一秒用力呼气容积占预计值百分比（FEV₁%pred）、pH[（中位数，四分位数间距）]、氧分压（PaO₂）和氧饱和度（SaO₂）均低于COPD组[（49.46±12.98）%对（54.38±11.72）%，（47.86±14.78）%对（57.78±15.81）%，7.37（7.34，7.39）对7.40（7.39，7.41），（80.75±10.20）对（84.28±8.43）mmHg（1 mmHg = 0.133 kPa），（94.46±2.52）%对（95.74±2.28）%]，而二氧化碳分压（PaCO₂）[（中位数，四分位数间距）]高于COPD组[55.00（45.50，60.00）对44.00（40.00，48.00）mmHg]（均P<0.05）。OS组的肺动脉压和血浆NT-proBNP水平[（中位数，四分位数间距）]显著高于COPD组[38.90（28.60，49.05）对28.60（24.95，32.60）mmHg，434.00（273.75，631.00）对136.00（86.00，205.00）pg/ml]（P<0.05）。偏相关分析显示，AHI与PaCO₂、肺动脉压、NT-proBNP及急性加重事件呈正相关（相关系数分别为：0.496、0.544、0.628、0.446），与FEV₁/FVC、FEV₁%pred、pH、PaO₂和SaO₂呈负相关（相关系数分别为：-0.309、-0.346、-0.410、-0.289、-0.267）（均P<0.05）。OS患者存在更严重的低氧血症、高碳酸血症和肺功能损害，其肺动脉压和NT-proBNP显著高于单纯COPD患者。
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