冠心病合并阻塞性睡眠呼吸暂停患者的血液生化指标分析

目的探讨冠心病合并阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)患者的多项血液生化指标的变化,旨在为合并有OSA的冠心病患者的治疗提供依据。方法 178例冠心病患者经多导睡眠监测(polysomnogra-phy,PSG),依据呼吸暂停低通气指数(apnea-hypopnea index,AHI),分为四组:OSA阴性组、轻度OSA组、中度OSA组、重度OSA组;检测各组患者的空腹血糖(FG)、糖化血红蛋白(HBA1c)、高敏C-反应蛋白(hsCRP)、氨基末端B型钠尿肽原(NT-proBNP)、血清甘油三酯(TG)、总胆固醇(TCHO)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)等指标,并将检测结果在各组间做比较。结果 FG在重度OSA组高于OSA阴性组、轻度OSA组和中度OSA组,差异有统计意义(P值分别为0.006、0.000、0.002),且随着OSA的加重而逐步增高;HBA1c在重度OSA组也高于其他三组,差异有统计意义(P值分别为0.004、0.001、0.023),且随着OSA的加重而逐步增高;hsCRP在OSA重度组高于OSA阴性组,差异有统计意义(P=0.040);NT-proBNP、TG、TCHO、HDL-C、LDL-C等各项目组间比较差异均无统计意义(P>0.05)。结论冠心病合并OSA的患者糖代谢紊乱突出;冠心病合并重度OSA的患者存在慢性系统性炎症。对合并有OSA的冠心病患者除常规冠心病、OSA治疗外,应早期筛查糖耐量,采取积极的降糖、抗炎症措施可能对其有益。

Biochemical indexes in coronary heart disease patients with obstructive sleep apnoea

Objective To investigate the variation and the significance of biochemical indexes in coronary heart disease （CHD） patients with obstructive sleep apnoea （OSA）. Methods According to apnea-hypopnea index（AHI）, 178 C HD patients were divided into four groups：no OSA group （n= 30）, mild OSA group（n= 57）,moderate OSA group（n = 53） and severe OSA group （n= 38）. Fasting glucose （FG）, glycohemoglobin A1c （ HBAle）, high-sensitivity C-reac- tive protein （ hsCRP）, N-terminal B-type natriuretic peptide （ NT-proBNP）, triglyceride （ TG）, total cholesterol （TCHO）,high density lipoprotein-cholesterol（HDL-C） and low density lipoprotein-cholesterol （LDL-C） Were meas- ured and compared among the four groups. Results The level of FG was significantly higher in severe OSA group than that in no OSA group,mild OSA group and moderate OSA group （P=0, 006,0. 000,0. 002） ,the level of HBAlc was also significantIy higher in severe OSA group than that in no OSA group,mild OSA group and moderate OSA group （P =0. 004,0. 001,0. 023）. FG and HBAlc had a trend to gradually increase with the severity of OSA. The level of hsCRP was higher in severe OSA group than that in no OSA group （P=0. 04）. The other indexes had no significant differences among the four groups （P〉0.05）. Conclusion There are significant glucose metabolism disorders in CHD patients with OSA,and CHD patients with severe OSA have chronic systemic inflammation. Early diagnoses and treatment for glucose disorder and systemic inflammation may be beneficial to these patients.