摘要
目的:探讨阻塞性睡眠呼吸暂停综合征(OSAHS)对急性心肌梗死(AMI)患者左心室功能、N末端B型利钠肽原(NT-proB-NP)、内皮素1(ET-1)、生长分化因子-15(GDF-15)的影响.方法:选取2020年3月至2022年6月于上海交通大学附属第六人民医院行急诊PCI的AMI患者136例,根据呼吸暂停低通气指数(AHI)水平将患者分为非OSAHS组(48例)、轻度OSAHS组(31例)、中度OSAHS组(29例)和重度OSAHS组(28例).均行心脏超声检查左心室功能指标[左室短轴缩短率(LVFS)、左室射血分数(LVEF)],检测血清NT-proBNP、ET-1、GDF-15、肌酸激酶(CK)、肌酸激酶同工酶MB(CK-MB)、乳酸脱氢酶(LDH)、α-羟丁酸脱氢酶(α-HBDH)水平.采用Pearson相关分析LVFS、LVEF、NT-proBNP、ET-1、GDF-15与AHI的相关性;采用多因素Logistic回归分析AMI合并OSAHS的影响因素.结果:(1)四组患者LVFS、LVEF比较,重度OSAHS组＜中度OSAHS组＜轻度OSAHS组＜非OSAHS组(P＜0.05);(2)四组患者NT-proBNP、ET-1、GDF-15水平比较,重度OSAHS组＞中度OSAHS组＞轻度OSAHS组＞非OSAHS组(P＜0.05);(3)四组患者CK、CK-MB、LDH、α-HBDH水平比较,重度OSAHS组＞中度OSAHS组＞轻度OS-AHS 组＞非 OSAHS 组(P＜0.05).(4)Pearson 相关性分析显示:AMI 患者 LVFS、LVEF 与 AHI 均呈负相关(r=-0.632、-0.573,P＜0.05),NT-proBNP、ET-1、GDF-15 水平与 AHI 均呈正相关(r=0.596、0.542、0.517,P＜0.05).(5)Logistic 回归分析显示:LVFS(OR=6.379,95％ CI:3.215～9.543)、LVEF(OR=3.016,95％ CI:1.364～4.668)、NT-proBNP(OR=5.171,95％ CI:2.316～8.025)、ET-1(OR=2.751,95％ CI:1.334～4.168)、GDF-15(OR=2.447,95％ CI:1.143～3.752)、CK(OR=4.108,95％ CI:1.615～6.602)、CK-MB(OR=4.500,95％ CI:1.860～7.139)、LDH(OR=3.435,95％ CI:1.407～5.463)是影响 AMI 合并 OSAHS 的独立危险因素(P＜0.05).结论:随着OSAHS病情进展可能加重AMI患者心功能、血管内皮功能、心肌损伤程度,血清NT-proBNP、ET-1、GDF-15水平升高可能是影响AMI患者并发OSAHS的危险因素.
Abstract
Objective:To investigate the effect of obstructive sleep apnea syndrome(OSAS)on left ventricular function,N-termi-nal pro-B-type natriuretic peptide(NT-proBNP),endothelin-1(ET-1),and growth differentiation factor-15(GDF-15)in patients with acute myocardial infarction(AMI).Methods:136 AMI patients who underwent emergency PCI at our hospital from March 2020 to June 2022 were selected and divided into non OSAHS group(48 cases),mild OSAHS group(31 cases),moderate OSAHS group(29 cases),and severe OSAHS group(28 cases)based on the apnea hypopnea index(AHI)level.Left ventricular function indicators[left ventricular fractional shortening shortening(LVFS),left ventricular ejection fraction(LVEF)]were examined by echocardiography,and the levels of NT-proBNP,ET-1,GDF-15,creatine kinase(CK),creatine kinase isoenzyme MB(CK-MB),lactate dehydrogenase(LDH),and α-Hy-droxybutyrate dehydrogenase(α-HBDH)were measured.Pearson correlation analysis was used to investigate the correlation between LVFS,LVEF,NT-proBNP,ET-1,GDF-15,and AHI;Multiple logistic regression analysis was used to analyze the risk factors of AMI with OSAHS.Results:(1)Comparison of LVFS and LVEF,the severe OSAHS group＜moderate OSAHS group＜mild OSAHS group＜non OSAHS group(P＜0.05);(2)Comparison of NT-proBNP,ET-1,and GDF-15 levels,the severe OSAHS group＞moderate OSAHS group＞mild OSAHS group＞non OSAHS group(P＜0.05);(3)Comparison of CK,CK-MB,LDH,and α-HBDH levels,the severe OSAHS group＞moderate OSAHS group＞mild OSAHS group＞non OSAHS group(P＜0.05).(4)Pearson correlation analysis showed that:the LVFS,LVEF were negatively correlated with AHI(r=-0.632,-0.573,P＜0.05),while NT-proBNP,ET-1,GDF-15 levels were positively correlated with AHI(r=0.596,0.542,0.517,P＜0.05).(5)Logistic regression analysis shows that:LVFS(OR=6.379,95％CI:3.215～9.543),LVEF(OR=3.016,95％ CI:1.364～4.668),NT-proBNP(OR=5.171,95％ CI:2.316～8.025),ET-1(OR=2.751,95％ CI:1.334～4.168),GDF-15(OR=2.447,95％ CI:1.143～3.752),CK(OR=4.108,95％ CI:1.615～6.602),CK-MB(OR=4.500,95％ CI:1.860～7.139),and LDH(OR=3.435,95％ CI:1.407～5.463)were independent risk factor for AMI with OSAHS(P＜0.05).Conclusions:As the condition of OSAHS progresses,it may worsen left ventricular function,vascular endothelial function,and myocardial damage in AMI patients.The levels of NT proBNP,ET-1,and GDF-15 were increased may be risk factors for AMI with OSAHS.
基金项目
上海市科技创新行动计划医学创新研究专项(20Y11910300)
万方数据