睡眠呼吸紊乱儿童上气道结构的MRI研究

目的探讨睡眠呼吸紊乱儿童上气道结构的特点。方法选择阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hyponea syndrom，OSAHS）组73例，原发性鼾症（primary snoring，Ps）组53例，对照组40例，进行咽、喉部睡眠状态下MRI检查。根据MRI结果对上气道相关空间结构、软组织和骨性结构进行多点测量。结果OSAHS组与PS组鼻咽气道截面积、腭咽气道截面积比对照组明显减小（P〈0．01），OSAHS组与PS组之间比较差异也有统计学意义；口咽气道截面积也均减小（P〈0，01），但睡眠呼吸紊乱两组之间比较差异无统计学意义。软组织测量：OSAHS组软腭截面积、软腭长度较对照组增大（P〈0．01），PS组无改变，OSAHS与Ps组比较差异有统计学意义（P〈0．05）；OSAHS组和PS组比对照组腺样体截面积增大、长度增宽，扁桃体截面积增大（P值均〈0．01），两组之间比较差异也有统计学意义；软腭厚度、舌体截面积、脂肪垫截面积、翼状肌截面积三组之间比较差异均无统计学意义。骨性结构测量：OSAHS组H-C2C3增长，颈舌角缩小（P值均〈0．01），PS组无改变。颈会厌角、硬腭长度、颏骨棘-斜坡间距离、下颌骨截面积、两侧下颌骨间距离三组之间比较差异均无统计学意义。结论OSAHS与PS组儿童因腺样体、扁桃体肥大致气道阻塞。软腭的增大加重了腭咽气道的阻塞，舌骨的下移与颈舌角变小影响了喉咽气道。MRI能较全面了解上气道结构，在儿童上气道阻塞诊断中有重要价值。

Magnetic resonance imaging of the upper airway structure of children with sleep disordered breathing

OBJECTIVE: To investigate the upper airway structure of sleep-disordered breathing children. METHODS: Seventy three children with obstructive sleep apnea hypopnea syndrome (OSAHS), 53 children with primary snoring (PS) and 40 control subjects underwent pharyngeal magnetic resonance imaging (MRI). Upper airway structure images were analyzed and measured. RESULTS: The cross-section area of the nasopharyngeal and palatopharyngeal airway in subjects with OSAHS and PS are smaller (P < 0.01) than that of the control group. The cross section area of OSAHS patients are smaller than that of PS subjects (P < 0.01). The above parameter of oropharyngeal airway in OSAHS patients is smaller than that of control group (P < 0.01), but no statistic difference compared with that of PS subjects. The cross-section area and length of the adenoid in OSAHS group are bigger and longer than that of PS group (P < 0.01) and bilateral tonsils are larger (P < 0.01); in OSAHS patients the cross-section area of the soft palate is larger and the length of the soft palate is longer (P < 0.01) than that of PS group, while this parameter of PS group is similar to that of the control group. And the maximum width of the soft palate, the cross-section area of bilateral fat pad, bilateral pterygoid and tongue are similar among OSAHS, PS and the control group. The skeletal measurement: the length of H-C2C3 in subjects with OSAHS is longer (P < 0.01); The angle(alpha) in OSAHS patients is smaller (P < 0.01) than that of other 2 groups. The angle (beta), the cross-section area of the mandible, the spine-clivus oblique, the length of the hard palate and the distance of the mandible are similar among the three groups. CONCLUSIONS: In children with OSAHS or PS, the upper airway is restricted by both the adenoid and tonsils; however, the soft palate is also larger in OSAHS, adding further restriction. Otherwise, downward movement of the hyoid bone and decreasing of the angle (alpha) in OSAHS influence larygopharynx airway. MRI is of clinical significance for evaluating OSAHS children's upper airway.