急性缺血性卒中患者阻塞性睡眠呼吸暂停低通气综合征与相关血液生化标志物的临床研究

doi:10.3969/j.issn.1673-5765.2020.05.016

摘要/Abstract

摘要：

目的探讨急性缺血性卒中患者阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apn ea hypopnea syndrome，OSAHS）与相关血液生化标志物的关系。方法纳入2018年1月-2019年12月郑州市第三人民医院及郑州市第二人民医院收治的急性缺血性卒中患者，根据多导睡眠图检测结果分为缺血性卒中伴OSAHS组和单纯缺血性卒中组，对比两组间一般资料、hs-CRP、D-二聚体（D-di mer，D-D）及纤维蛋白原降解产物（fibrinogen degradation products，FDP）的差异。根据OSAHS严重程度，分为轻度OSAHS组，中度OSAHS组，重度OSAHS组，并比较3组患者hs-CRP、 D-D及FDP的差异。结果共纳入98例患者，其中缺血性卒中伴OSAHS组59例，单纯缺血性卒中组39例；缺血性卒中伴OSAHS组中轻度OSAHS 19例，中度OSAHS 16例，重度OSAHS 24例。缺血性卒中伴OSAHS组的 BM（I 26.33±4.16 kg/m2 vs 23.93±3.83 kg/m2，P =0.048）、hs-CRP（11.95±3.11 mg/L vs 6.13±1.69 mg/L，P ＜0.001）、D -D [0.78（0.38～1.21）m g/L vs 0.25（0.14～0.30）m g/L，P＜0.001]、FDP （3.36±1.39 μg/mL vs 2.30±0.88 μg/mL，P =0.005）均高于单纯缺血性卒中组。轻度OSAHS组（7.92±2.15 mg/L，P＜0.001）和中度OSAHS组（11.47±2.54 mg/L，P＝0.005）hs-CRP水平均低于重度 OSAHS组（15.31±3.16 mg/L），轻度OSAHS组hs-CRP水平低于中度OSAHS组（P＝0.012）。轻度OSAHS 组D-D水平低于重度OSAHS组[0.42（0.23～0.98）mg/L vs 0.98（0.93～1.85）mg/L，P＝0.023]，轻度 OSAHS组FDP水平低于重度OSAHS组（2.74±0.93 μg/mL vs 4.19±1.55 μg/mL，P =0.012）。结论与不伴OSAHS的急性缺血性卒中患者相比，伴有OSAHS的急性缺血性卒中患者血清hs-CRP、 D-D、FDP水平更高。

文章导读： 本研究通过病例对照分析发现，与不伴OSAHS的急性缺血性卒中患者相比，伴有OSAHS的急性缺血性卒中患者血清hs-CRP、D-D、FDP水平更高。

关键词: 急性缺血性卒中; 阻塞性睡眠呼吸暂停低通气综合征; 高敏C反应蛋白; D-二聚体; 纤维蛋白原降解产物

Abstract:

Objective To explore the relationship between obstructive sleep apnea hypopnea syndrome (OSAHS) and related blood biochemical markers in patients with acute ischemic stroke. Methods Patients with acute ischemic stroke(AIS) admitted to the Third People's Hospital of Zhengzhou and the Second People's Hospital of Zhengzhou from January 2018 to December 2019 were included in this study. All the patients were divided into only AIS group and AIS+OSAHS group according to the results of polysomnography. The general information, hs-CRP, D-dimer (D-D) and fibrinogen degradation products (FDP) levels between the two groups were compared.

According to the severity of OSAHS, all the patients were divided into mild OSAHS subgroup, moderate OSAHS subgroup, and severe OSAHS subgroup, and the differences in the levels of hs- CRP, D-D and FDP among 3 groups were compared. Results A total of 98 patients were included, 59 cases in AIS+OSAHS group and 39 cases in only AIS group, including 19 cases in mild OSAHS subgroup, 16 cases in moderate OSAHS subgroup, and 24 cases in severe OSAHS subgroup. BMI (26.33±4.16 kg/m2 vs 23.93±3.83 kg/m2, P =0.048), hs-CRP (11.95±3.11 mg/L vs 6.13±1.69 mg/L, P <0.001), D-D [0.78 (0.38-1.21) mg/L vs 0.25 (0.14-0.30) mg/L, P <0.001], FDP (3.36±1.39 μg/mL vs 2.30±0.88 μg/mL, P =0.005) were higher in AIS+OSAHS group than that in only AIS group. hs-CRP level in mild OSAHS subgroup (7.92±2.15 mg/L, P <0.001) and moderate OSAHS subgroup (11.47±2.54 mg/L, P =0.005) were lower than that in severe OSAHS subgroup (15.31±3.16 mg/L), and the mild OSAHS subgroup was lower than moderate OSAHS subgroup (P =0.012). D-D level in mild OSAHS subgroup [0.42 (0.23-0.98) mg/L vs 0.98 (0.93-1.85) mg/L, P =0.023] was lower than that in severe OSAHS subgroup, FDP level in mild OSAHS subgroup (2.74±0.93 μg/mL vs 4.19±1.55 μg/mL, P =0.012) was lower than that in severe OSAHS subgroup. Conclusions Compared with AIS patients without OSAHS, AIS patients with OSAHS had higher levels of serum hs-CRP, D-D and FDP.

Key words: Acute ischemic stroke; Obstructive sleep apnea-hypopnea syndrome; High sensitivity C-reactive protein; D-dimer; Fibrinogen degradation product

嵇朋，江利敏，孙根，寇启星，屈雪萍，孙雅静，孟凡超，周衡. 急性缺血性卒中患者阻塞性睡眠呼吸暂停低通气综合征与相关血液生化标志物的临床研究[J]. 中国卒中杂志, 2020, 15(05): 550-554.

JI Peng, JIANG Li-Min, SUN Gen, KOU Qi-Xing, QU Xue-Ping,SUN Ya-Jing, MENG Fan-Chao, ZHOU Heng. The Relationship between Obstructive Sleep Apnea Hypopnea Syndrome and Related Blood Biochemical Markers in Patients with Acute Ischemic Stroke[J]. Chinese Journal of Stroke, 2020, 15(05): 550-554.

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