上气道CT软组织测量值与阻塞性睡眠呼吸暂停低通气综合征病情程度的关系

目的 探讨上气道形态学指标尤其是气道壁软组织体积与阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者病情严重程度的关系.方法 经多道睡眠图监测确诊的82例OSAHS患者行平静呼吸时的上气道CT扫描,并行三维重建,测量上气道不同部位的左右径、截面积,尤其是气道腔内容积、气道壁软组织体积等指标,并进行各测量值与呼吸暂停低通气指数(AHI)、最低动脉血氧饱和度(lowest arterial oxygen saturation,LSaO2)的相关性分析.结果 各研究平面的左右径、面积与AHI的大小均呈负相关,与LSaO2呈正相关,尤其是AHI与整个气道的最小左右径相关性更明显(r=-0.558,P<0.01).AHI与鼻腔骨性容积、鼻咽腔内容积、腭咽气道腔内容积、腭咽气道腔内容积占腭咽骨性框架包绕容积的比值、整个气道腔内容积占整个气道骨性框架包绕容积的比值均呈不同程度的负相关(P值<0.05或<0.01),同时与腭咽气道壁软组织体积、腭咽气道壁软组织体积占腭咽骨性框架内包绕容积的比值、整个气道壁软组织体积占整个气道骨性框架包绕容积的比值,腭咽气道壁软组织体积与腭咽腔内容积的比值、整个气道壁软组织体积与整个气道腔内容积的比值均呈正相关(P值<0.05或<0.01).结论 OSAHS患者上气道CT测量二维指标与三维指标均可对OSAHS病情严重程度的预测提供一定的参考信息.气道的左右径、面积及气道腔内容积、气道壁软组织体积,尤其是腭咽区气道腔内容积及气道壁软组织体积,对病情的判别均有意义.

Correlation between upper airway soft tissue 3-D measurement and the severity of obstructive sleep apnea hypopnea syndrome

Objective To investigate the correlation between upper airway CT measurement value and severity of patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods The upper airway of 82 patients with OSAHS were scanned by CT during normal respiration. The 3-D CT measurement were made in lateral and anterior-posterior diameters, cross-section areas and volumes of retropalatal and retroglossal region. Results The lateral diameters and cross-section areas of every research plane were negatively correlated with apnea and hypopnea index (AHI) , in particular the minimal lateral diameter of the whole airway(r =-0. 558, P <0. 01). For volumes, AHI decreased with larger volume of nasal cavity, nasopharyngeal cavity and velopharyngeal cavity (P < 0. 05 or P < 0. 01 ). The negative correlation between AHI and proportion of cavity volume to the bone frame of velopharyngeal area and whole upper airway were significant (P <0. 05 or P < 0. 01). But the correlation between AHI and volume of velopharyngeal soft tissue, the proportion of soft tissue to the bone frame volume of velopharyngeal area, the proportion of soft tissue to the bone frame volume of whole upper airway was significant positive, as well as the correlation between AHI and the proportion of soft tissue to the cavity volume of velopharyngeal area and whole upper airway (P<0. 05 or P<0. 01). Conclusions To evaluate the severity of OSAHS with upper airway CT measurement, there is no difference between 3-D parameters and 2-D parameters. In terms of the whole airway, the lateral diameters, the cross-section area, the cavity volume, the soft tissue of the upper airway,are meaningful to evaluate the severity of disease.in particular the measurement of velopharyngeal area.