阻塞性睡眠呼吸暂停低通气综合征患者血红蛋白含量的变化

目的 探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血红蛋白含量的变化.方法 对1 680例研究对象行睡眠呼吸监测,根据监测结果,将患者分为OSAHS组(1 280例)与对照组(400例).根据睡眠呼吸暂停低通气指数(AHI),OSAHS患者进一步分为轻度组(477例),中度组(369例)和重度组(434例).根...     

老年代谢综合征合并阻塞性睡眠呼吸暂停综合征的临床分析

目的探讨老年人群代谢综合征（MS）合并阻塞性睡眠呼吸暂停综合征（OSAHS）的患病情况,分析各组别之间的相关性。方法对我院老年科诊断为MS的患者进行日间嗜睡情况调查和多导睡眠监测,调查OSAHS的患病率;将MS患者分为四组：非OSAHS组、轻度OSAHS组、中度OSAHS组和重度OSAHS组,比较不同程度OSAHS组的体重、腰围和BMI情况;对患者的夜间睡眠呼吸紊乱和体重、腰围、BMI做相关性分析;比较不同程度OSAHS患者的MS的组构成差异;分析OSAHS的严重程度与MS组的相关性。结果（1）64例符合MS诊断标准,55例完成多导睡眠图（PSG）,其中49例（89．1％）诊断为OSAHS;（2）非OSAHS组的腰围、BMI和体重显著低于重度OSAHS组ESS评分显著低于中度OSAHS和重度OSAHS组;（3）Z综合征患者呼吸暂停低通气指数（AHI）及氧减饱和指数（ODI）均与腰围和BMI呈正相关,最低氧饱和度（LSaO2）与BMI呈负相关;（4）四组患者MS各组构成比无明显差异,但OSAHS随MS组增多存在加重趋势。结论老年MS人群中OSAHS患病率极高,OSAHS随腰围和BMI的升高而加重。符合MS诊断较多组的患者,OSAHS的严重程度也较高。     

阻塞性睡眠呼吸暂停低通气综合征严重程度对射频消融术后心房颤动复发的影响

目的:观察不同程度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)对心房颤动射频消融效果的影响,并探讨OSAHS患者心房颤动复发的预测因素。方法:回顾性分析自2011年01月至2015年06月,在北京安贞医院行导管消融术并经多导睡眠监测诊断为OSAHS的心房颤动患者126例,根据睡眠呼吸暂停低通气指数(AHI)分为轻度OSAHS组22例,中度OSAHS组47例,重度OSAHS组57例,比较各组患者基础资料及心房颤动复发率,对可能影响OSAHS患者术后心房颤动复发的因素行单因素分析和Logistic回归分析。结果:术后平均随访(16.5±14.3)个月,重度OSAHS患者心房颤动复发率为66.7%,明显高于轻度OSAHS患者复发率36.4%(P=0.014),但与中度OSAHS患者复发率57.4%差异无统计学意义(P=0.334)。经多因素二元Logistic回归分析显示,AHI(OR=1.04,95%CI:1.01~1.08,P=0.016)、体质量指数(BMI)(OR=1.12,95%CI:1.00~1.26,P=0.045)、冠心病病史(OR=4.38,95%CI:1.09~17.52,P=0.037)和左心室舒张末径(LVEDD)(OR=1.11,95%CI:1.03~1.20,P=0.006)是OSAHS患者心房颤动复发的预测因素。进一步校正左心房前后径(LAD),Logistic回归分析发现只有LAD是复发的独立预测因素(OR=1.30,95%CI:1.16~1.46,P0.0001)。结论:OSAHS严重程度与心房颤动射频消融术的复发相关,AHI、BMI、LAD、LVEDD和冠心病病史是影响OSAHS患者心房颤动导管消融复发的重要因素。     

原发性高血压伴阻塞性睡眠呼吸暂停低通气综合征患者左心室肥厚及其功能改变的危险因素

目的探讨原发性高血压伴阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者左心室肥厚(LVH)及其功能改变的危险因素。方法选取2011年1月至2014年1月就诊于新疆医科大学第一附属医院的高血压患者499例,男性321例,女性178例,根据睡眠呼吸暂停低通气指数(AHI)分为4组:AHI5次/h为单纯高血压组(EH组,n=24)、5~15次/h为高血压伴轻度OSAHS组(轻度组,n=208)、15~30次/h为高血压伴中度OSAHS组(中度组,n=156)、AHI30次/h为高血压伴重度OSAHS组(重度组,n=111)。采用心脏超声心动图测定左心室相关参数与收缩、舒张功能,并对比各组左心室相关参数,对研究资料进行单因素方差分析和多因素Logistic回归分析影响左心室结构及其收缩、舒张功能的因素。结果中、重度OSAHS组左心室舒张末内径(LVEDD)、室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、左心室质量指数(LVMI)高于轻度OSAHS组及单纯高血压组;二尖瓣血流频谱舒张早期最大血流速度/舒张晚期最大血流速度(E/A)低于轻度OSAHS组及单纯高血压组(1.01±0.32、0.95±0.28比1.15±0.33、1.28±0.21;P0.05);重度OSAHS组左心室射血分数(LVEF)低于轻度OSAHS组[(63.84±3.71)%比(65.40±3.27)%,P0.05]。多因素Logistic回归分析结果显示,性别(OR=0.240)、血压未达标(OR=2.256)、AHI(OR=2.115)为LVMI的影响因素;AHI(OR=2.212)为LVEF的影响因素;年龄(OR=2.723)、血压未达标(OR=1.627)、AHI(OR=1.786)为E/A的影响因素。结论女性、血压、AHI为LVH的危险因素;AHI为左心室收缩功能的危险因素;年龄、血压、AHI为左心室舒张功能的危险因素。     

不同程度阻塞性睡眠呼吸暂停低通气综合征的相关因素

目的探讨不同程度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的高危因素。方法回顾性分析2016年3月至2018年3月解放军总医院睡眠医学中心OSAHS患者190例,根据睡眠呼吸暂停低通气指数分为轻度组54例(5~15次/h)、中度组(16~30次/h)57例和重度组(>30次/h)79例,比较3组患者便携式睡眠呼吸监测(PM)结果,多分类logistic回归分析不同程度OSAHS的危险因素。应用SPSS 22.0统计软件对数据进行分析。依据数据类型采用单因素方差分析或χ2检验进行组间比较。结果3组患者睡眠呼吸暂停低通气指数、最低血氧饱和度、平均血氧饱和度、氧减指数和呼吸暂停次数差异均有统计学意义(P<0.05)。多分类logistic回归分析结果表明年龄40~50岁是轻度和重度OSAHS的危险因素[OR=5.740,95%CI 1.657~19.930,P=0.006;OR=0.120,95%CI 0.025~0.575,P=0.008]。年龄>50岁是轻度OSAHS的危险因素[OR=3.325,95%CI 1.036~10.674;P=0.043]。颈围是不同程度OSAHS的危险因素。体质量指数是中度和重度OSAHS的危险因素[OR=0.832,95%CI 0.694~0.996,P=0.045;OR=0.903,95%CI 0.777~1.051,P=0.018]。结论颈围是不同程度OSAHS的危险因素,体质量指数与OSAHS患者病情加重相关,密切关注它们对控制OSAHS病情具有重要意义。     

不同严重度阻塞性睡眠呼吸暂停低通气综合征女性血压影响因素分析

目的:探讨不同严重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)女性患者血压的影响因素。方法:将190例2009至2011年就诊于上海交通大学医学院附属瑞金医院睡眠中心的女性打鼾患者按睡眠呼吸暂停低通气指数(AHI)分成4组:非OSAHS组、轻度OSAHS组、中度OSAHS组和重度OSAHS组,比较这4组患者的一般特征、多导睡眠图(PSG)监测指标及血压的差异,并分析不同OSAHS严重度组血压影响因素。结果:非OSAHS组43例,轻度OSAHS组52例,中度OSAHS组30例,重度OSAHS组65例。随着AHI升高,各组血压值呈升高趋势。各组血压比较,重度OSAHS组收缩压与非OSAHS组比较有显著差异(P<0.05);重度OSAHS组舒张压高于非OSAHS组及轻度OSAHS组(P     

Z综合征呼吸暂停程度与血压变异性相关研究

目的探讨Z综合征患者血压变异性特点及睡眠呼吸暂停与血压变异性的关系。方法共入选2011年6月至2012年12月北京大学人民医院收治的代谢综合征(MS)患者192例,根据多导睡眠监测(PSG)结果将患者分为单纯MS组(88例),MS合并轻度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)组(MS+轻度OSAHS,53例),MS合并中重度OSAHS组(MS+中重度OSAHS,51例),对3组患者行动态血压监测(ABPM)。结果 Z综合征患者24h平均血压、夜间及白天平均血压高于单纯MS组。Z综合征患者24 h血压、夜间及白天血压变异性高于单纯MS组;OSAHS程度越重,Z综合征患者血压变异性越大,呼吸暂停低通气指数(AHI)与24h收缩压变异性呈正相关,与夜间收缩压下降率呈负相关。结论 OSAHS不仅加重MS的平均血压水平,也加重血压变异性。对收缩压短时血压变异影响更大。     

高血压并发阻塞性睡眠呼吸暂停低通气综合征患者血清氧化低密度脂蛋白水平的变化

目的研究高血压并发阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血清氧化低密度脂蛋白(ox-LDL)水平变化及其临床意义。方法选取2004年4月至2011年10月322例高血压患者,根据睡眠呼吸暂停低通气指数(AHI)将患者分为四组:不伴OSAHS的单纯高血压组(对照组,57例),轻度OSAHS合并高血压组(轻度组,86例),中度OSAHS合并高血压组(中度组,97例),重度OSAHS合并高血压组(重度组,81例)。采用ELISA方法测定患者血浆ox-LDL浓度。结果随着血压的增高,AHI在各组间具有显著差异(P<0.05)。此外,随着AHI的升高,患者的血压水平逐渐升高。三组OSAHS患者ox-LDL水平显著高于单纯高血压组(P<0.05),重度组ox-LDL水平显著高于轻度组和中度组(P<0.05)。逐步Logistic回归分析发现,不同组BMI、ox-LDL水平差异有统计学意义(P<0.05)。结论 ox-LDL水平与高血压并发OSAHS严重程度相关。     

阻塞性睡眠呼吸暂停低通气综合征患者血液流变学观察

目的 观察阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者的血液流变学情况.方法 选择OSAHS患者65例（OSAHS组）和健康查体者50例（对照组）,行睡眠监测测定睡眠呼吸暂停低通气指数（AHI）、夜间最低SaO2,采用血流变仪检测血液流变学指标.结果 与OSAHS组轻中度患者和对照组比较,OSAHS组重度（病程≥3a）患者全血黏度、血浆黏度、全血还原黏度、红细胞压积均升高,夜间最低SaO2降低,P均＜0.05;而OSAHS组轻中度患者和对照组比较,P均＞0.05.AHI与血流变水平呈正相关（rs=0.384,P＜0.05）,夜间最低SaO2与血流变水平呈负相关（rs=-0.282,P＜0.05）.结论 AHI、夜间最低SaO2和病程对OSAHS患者血液流变学指标均有明显影响,观察血液流变学指标对OSAHS患者的病情发展和疗效观察具有一定价值.     

阻塞性睡眠呼吸暂停低通气综合征与高血压患者夜间收缩压波动程度的相关性研究

目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与高血压患者夜间收缩压波动程度的相关性。方法对69例疑诊OSAHS高血压患者行多导睡眠及脉搏波传导时间法无创血压监测,根据睡眠呼吸暂停低通气指数(AHI)分为对照组(AHI5)、轻度组(5≤AHI≤15)、中度组(15AHI≤30)、重度组(AHI30),比较各组夜间收缩压波动相关参数及多导睡眠监测参数,并行相关性分析。结果 OSAHS轻、中、重度组睡眠期呼吸相关收缩压上升指数、收缩压上升平均值(ASVs)、快动眼睡眠期收缩压标准差(SDs)显著高于对照组(均P0.05);ASVs及SDs与脉搏血氧饱和度均呈负相关(均P0.01);与AHI及其它缺氧相关参数均呈正相关(均P0.01)。多元线性回归分析示氧减指数是影响呼吸相关收缩压上升指数的重要因素(B=0.400,t=3.128,P=0.003)。结论高血压并OSAHS患者夜间收缩压波动程度增加,间歇性低氧血症与收缩压波动程度增加密切相关。     

Takotsubo syndrome: the broken-heart syndrome

Takotsubo syndrome – also known as broken-heart syndrome, Takotsubo cardiomyopathy, and stress-induced cardiomyopathy – is a recently discovered acute cardiac disease first described in Japan in 1991. This review aims to update understanding on the epidemiology, pathophysiology, clinical presentation, diagnosis, and treatment of Takotsubo syndrome, highlighting aspects of interest to cardiologists and general practitioners.Key words: broken-heart syndrome, stress cardiomyopathy, Takotsubo cardiomyopathy, Takotsubo syndrome     

Myelodysplastic syndrome accompanied by Evans syndrome

Various cases of myelodysplastic syndrome (MDS) with diverse immunological disorders have been reported by many investigators. In this case report, we present a 70-year-old woman who had been diagnosed as having MDS and liver cirrhosis (LC) type C for 20 months, and who finally developed autoimmune phenomena against autologous blood cells. She was admitted to our hospital in order to evaluate her advanced anemia, thrombocytopenia and fatigue. The laboratory data at admission were as follows: hemoglobin 5.3 g/dl, red blood cell count 109 x 10(4)/microliter, white blood cell count 1,760/microliter, platelet count 4.3 x 10(4)/microliter and reticulocyte count 1.3%. The direct Coombs test was positive. In addition, anti-platelet antibody was positive, using the MPHA method. With these results, Evans syndrome secondary to MDS or LC was diagnosed. The mechanisms for the development of immunological disorders in patients with MDS or LC have not been fully elucidated. To our knowledge, this patient is one of the rare cases with MDS and Evans syndrome reported in the literature. During the generation process of autoantibodies, the role of HCV antigen in the pathogenesis of Evans syndrome was of interest in this patient.     

Broken-heart syndrome (Takotsubo syndrome)

We report on the rare case of partial anomalous return of four pulmonary veins in the right atrium and superior vena cava with intact interatrial septum in a five-year-old child. There were few symptoms in contrast with the left ventricular output dependent on the flow of the left upper lobe vein and from the lingula. Reduced compliance to the left led to a severe picture of pulmonary venocapillary hypertension in the immediate postoperative period, mitigated by an 8-mm interatrial septal defect. The patient progressed well after the intervention.     

Sweet's syndrome associated with myelodysplastic syndrome

A 49-year-old man was hospitalized because of cutaneous plaques and pancytopenia. Hematological findings, and the skin eruption suggested Sweet's syndrome associated with myelodysplastic syndrome (refractory anemia with excess of blasts; RAEB). Treatment for pancytopenia was attempted without effect. Also we tried treatment with antibiotics. The skin lesions healed and the body temperature returned to normal. This case was unusual in the association of myelodysplastic syndrome with Sweet's syndrome.     

Cronkhite-Canada syndrome associated with myelodysplastic syndrome

We report a case of Cronkhite-Canada syndrome (CCS) associated with myelodysplastic syndrome (MDS). A 54-year-old woman, diagnosed as MDS the prior year after evaluation of anemia, visited our hospital with the chief complaint of epigastric discomfort. She also had dysgeusia, alopecia, atrophic nail change, and pigmentation of the palm, all of which began several months ago. Blood tests revealed severe hypoalbuminemia. Colonoscopy (CS) showed numerous, dense, red polyps throughout the colon and rectum. Biopsy specimens showed stromal edema, infiltration of lymphocytes, and cystic dilatation of the crypt. Her clinical manifestations and histology were consistent with CCS. We prescribed corticosteroids, which dramatically improved her physical findings, laboratory data, and endoscopic findings. This is the first report of CCS in a patient with MDS.