腭咽后区MRI测量参数对持续正压通气OSAHS患者临床评估的价值
|
摘要
目的分析腭咽后区MRI测量参数对持续正压通气(continuous positive airway pressure, CPAP)治疗阻塞性睡眠呼吸暂停低通气综合征(obstructive sleepapnea hypopnea syndrome, OSAHS)患者病情评估的价值。方法选择2016年12月—2018年2月我院收治的OSAHS患者83例,按照病情程度分为轻度组(睡眠呼吸暂停低通气指数5～14/h)22例、中度组(睡眠呼吸暂停低通气指数15～30/h)24例、重度组(睡眠呼吸暂停低通气指数>30/h)37例。观察各组气道阻塞部位及腭咽平面狭窄因素;对比观察不同程度OSAHS患者CPAP治疗期间MRI影像学测量参数,及其与病情程度的相关性;观察3组身高、体重、体重指数(BMI)及颌下脂肪厚度水平。结果随着病情的加重,单一部位阻塞率逐渐降低,腭咽合并舌咽部阻塞率逐渐升高,差异均有统计学意义(P<0.05或P<0.01)。重度组软腭肥厚、过长及悬雍垂后坠和腭扁桃体肥大发生率明显高于轻度组、中度组(P<0.05或P<0.01)。3组OSAHS患者腭咽后区气道最小截面积、气道横径、气道前壁软组织厚度和气道构成比均比较差异有统计学意义(P<0.05或P<0.01),其中重度组患者腭咽后区气道最小截面积、气道横径均小于轻度组、中度组,气道前壁软组织厚度、气道构成比大于轻度组、中度组,差异均有统计学意义(P均<0.05);且中度组腭咽后区气道最小截面积、气道横径亦小于轻度组,气道前壁软组织厚度和气道构成比亦大于轻度组,差异均有统计学意义(P均<0.05)。相关性分析结果显示,气道最小截面积、气道横径与OSAHS病情呈负相关,气道前壁软组织厚度和气道构成比与OSAHS病情呈正相关。3组患者体重、BMI和颌下脂肪厚度比较差异有统计学意义(P<0.01),而重度组患者体重、BMI及颌下脂肪厚度明显大于中度、轻度组患者(P均<0.05)。结论 OSAHS发病机制复杂,随着病情程度的加重,OSAHS患者同时合并腭咽部及舌咽部多部位阻塞发生率升高。OSAHS患者CPAP治疗期间可依据MRI影像学测量参数客观评价气道重塑改变情况,定量评价气道梗阻情况,进而有利于评估病情及疗效。
Objective To analyze the value of MRI parameters in the retropharyngeal region of the palate in evaluating the condition and therapeutic effect of patients with obstructive sleep apnea hypopnea syndrome(OSAHS) treated with continuous positive airway pressure(CPAP). Methods From December 2016 to February 2018, 83 patients with OSAHS were divided into mild group(22 cases), moderate group(24 cases) and severe group(37 cases). Comparing the difference of airway obstruction site and palatopharyngeal plane stenosis factors in each group; Observing the difference of MRI measurement parameters during CPAP treatment in OSAHS patients with different degrees, and its correlation with the severity of the disease. Results With the aggravation of the disease, the obstructive rate of single site decreased gradually, and the obstructive rate of palatopharynx and glossopharynx increased gradually(P<0.05 or P<0.01). The incidence of soft palate hypertrophy, long, uvula drop and palatal tonsil hypertrophy in severe group was significantly higher than that in mild group and moderate group(P<0.05 or P<0.01). There were significant differences in the minimum cross-sectional area, transverse diameter, soft tissue thickness of anterior airway wall and the ratio of airway composition among the three groups, and there were significant differences between mild group and moderate group(P<0.05 or P<0.01), and the minimum cross-sectional area and transverse diameter of the posterior palatopharyngeal airway in the moderate group were also smaller than those in the mild group, and the thickness of the anterior airway soft tissue and the ratio of airway components were also greater than those in the mild group(P<0.05). Correlation analysis showed that the minimum cross-sectional area and transverse diameter of the airway were negatively correlated with the condition of OSAHS, and the thickness of anterior airway soft tissue and the ratio of airway components were positively correlated with the condition of OSAHS. There were significant differences in body weight, BMI and submandibular fat thickness among the three groups(P<0.01). The body weight, BMI and submandibular fat thickness in the severe group were significantly higher than those in the moderate and mild group(P<0.05). Conclusion The pathogenesis of OSAHS is complex. With the aggravation of the disease, the incidence of multiple obstruction in the palatopharynx and glossopharynx is increased in OSAHS patients. During CPAP treatment of OSAHS patients, MRI imaging parameters can be used to objectively evaluate the changes of airway remodeling after treatment, quantitatively evaluate airway obstruction, and then help to evaluate the condition and treatment effect.
Objective To analyze the value of MRI parameters in the retropharyngeal region of the palate in evaluating the condition and therapeutic effect of patients with obstructive sleep apnea hypopnea syndrome(OSAHS) treated with continuous positive airway pressure(CPAP). Methods From December 2016 to February 2018, 83 patients with OSAHS were divided into mild group(22 cases), moderate group(24 cases) and severe group(37 cases). Comparing the difference of airway obstruction site and palatopharyngeal plane stenosis factors in each group; Observing the difference of MRI measurement parameters during CPAP treatment in OSAHS patients with different degrees, and its correlation with the severity of the disease. Results With the aggravation of the disease, the obstructive rate of single site decreased gradually, and the obstructive rate of palatopharynx and glossopharynx increased gradually(P<0.05 or P<0.01). The incidence of soft palate hypertrophy, long, uvula drop and palatal tonsil hypertrophy in severe group was significantly higher than that in mild group and moderate group(P<0.05 or P<0.01). There were significant differences in the minimum cross-sectional area, transverse diameter, soft tissue thickness of anterior airway wall and the ratio of airway composition among the three groups, and there were significant differences between mild group and moderate group(P<0.05 or P<0.01), and the minimum cross-sectional area and transverse diameter of the posterior palatopharyngeal airway in the moderate group were also smaller than those in the mild group, and the thickness of the anterior airway soft tissue and the ratio of airway components were also greater than those in the mild group(P<0.05). Correlation analysis showed that the minimum cross-sectional area and transverse diameter of the airway were negatively correlated with the condition of OSAHS, and the thickness of anterior airway soft tissue and the ratio of airway components were positively correlated with the condition of OSAHS. There were significant differences in body weight, BMI and submandibular fat thickness among the three groups(P<0.01). The body weight, BMI and submandibular fat thickness in the severe group were significantly higher than those in the moderate and mild group(P<0.05). Conclusion The pathogenesis of OSAHS is complex. With the aggravation of the disease, the incidence of multiple obstruction in the palatopharynx and glossopharynx is increased in OSAHS patients. During CPAP treatment of OSAHS patients, MRI imaging parameters can be used to objectively evaluate the changes of airway remodeling after treatment, quantitatively evaluate airway obstruction, and then help to evaluate the condition and treatment effect.
引文
[1] 吴莉,王继群,唐智,等.重度阻塞性睡眠呼吸暂停低通气综合征合并高血压对心脏结构和功能的影响[J].中国临床研究,2016,29(4):536-538.
[2] 黄泰博,马利军,牛红丽.持续正压通气治疗阻塞性睡眠呼吸暂停低通气综合征的依从性研究进展[J].中国综合临床,2011,27(6):661-664.
[3] 董万里,王海播,马利军,等.阻塞性睡眠呼吸暂停低通气综合征与氧化应激研究进展[J].中国综合临床,2013,29(6):670-672.
[4] 戈录芳,康翠清,张秀兰.儿童阻塞性睡眠呼吸暂停低通气综合征多导睡眠监测分析[J].临床误诊误治,2012,25(2):86-88.
[5] Dudoignon B, Amaddeo A, Frapin A, et al. Obstructive sleep apnea in Down syndrome: Benefits of surgery and noninvasive respiratory support[J].Am J Med Genet A, 2017,173(8):2074-2080.
[6] 徐庆庆,李向阳.阻塞性睡眠呼吸暂停低通气综合征研究进展[J].实用医院临床杂志, 2016,13(1):138-141.
[7] 中华医学会呼吸病学分会睡眠呼吸疾病学组.阻塞性睡眠呼吸暂停低通气综合征诊治指南(草案)[J].中华结核和呼吸杂志,2002,25(4):195-198.
[8] 李飞燕,况九龙.阻塞性睡眠呼吸暂停低通气综合征的异质性及临床分型研究进展[J].山东医药,2016,56(22):98-101.
[9] 刘志强,俞森洋,徐江祥,等.呼吸道正压通气治疗2型糖尿病伴阻塞性睡眠呼吸暂停低通气综合征的临床研究[J].中华保健医学杂志,2012,14(4):286-288.
[10] 闫芳,夏宇,贺家勇,等.阻塞性睡眠呼吸暂停低通气综合征患者气道炎症及气管壁厚度变化[J].中国全科医学,2016,19(5):529-532.
[11] 林娜,李彦如,李天佐,等. 阻塞性睡眠呼吸暂停低通气综合征患者围术期上气道评估[J].首都医科大学学报,2013,34(5):646-650.
[12] 卜小宁,郭兮恒,王辰,等. 阻塞性睡眠呼吸暂停低通气综合征120例临床分析[J].首都医科大学学报,2006,27(1):81-83.
[13] 刘文君,于雪莹,吕丹,等.不同性别阻塞性睡眠呼吸暂停低通气综合征患者与上气道影像学相关性的研究[J].山东大学耳鼻喉眼学报,2017,31(4):54-59.
[14] 肖水芳,贾俊晓,张俊波.阻塞性睡眠呼吸暂停低通气综合征治疗进展[J].临床耳鼻咽喉头颈外科杂志,2016,30(24):1909-1912.
[15] 姜晶,周秀梅.持续气道正压通气在阻塞性睡眠呼吸暂停低通气综合征合并冠心病治疗中的作用观察[J].中国药师,2016,19(6):1105-1107.
[16] Kuang J. Obstructive Sleep Apnea-Hypopnea Syndrome Clinical in Subtypes a Principal Component Analysis-Based Cluster Analysis[J].Chest, 2016,149(4):A566-A566.
[17] 张博薇,彭德昌,粟丽,等.阻塞性睡眠呼吸暂停低通气综合征对上气道咽侧壁及腮腺和颌下脂肪的影响[J].中国全科医学,2017,20(3):314-317.
[18] 王洪洪,李进让,赵鹏举,等.成年阻塞性睡眠呼吸暂停低通气综合征患者体重指数与颈围的性别差异分析[J].临床误诊误治,2016,29(4):94-96.
[2] 黄泰博,马利军,牛红丽.持续正压通气治疗阻塞性睡眠呼吸暂停低通气综合征的依从性研究进展[J].中国综合临床,2011,27(6):661-664.
[3] 董万里,王海播,马利军,等.阻塞性睡眠呼吸暂停低通气综合征与氧化应激研究进展[J].中国综合临床,2013,29(6):670-672.
[4] 戈录芳,康翠清,张秀兰.儿童阻塞性睡眠呼吸暂停低通气综合征多导睡眠监测分析[J].临床误诊误治,2012,25(2):86-88.
[5] Dudoignon B, Amaddeo A, Frapin A, et al. Obstructive sleep apnea in Down syndrome: Benefits of surgery and noninvasive respiratory support[J].Am J Med Genet A, 2017,173(8):2074-2080.
[6] 徐庆庆,李向阳.阻塞性睡眠呼吸暂停低通气综合征研究进展[J].实用医院临床杂志, 2016,13(1):138-141.
[7] 中华医学会呼吸病学分会睡眠呼吸疾病学组.阻塞性睡眠呼吸暂停低通气综合征诊治指南(草案)[J].中华结核和呼吸杂志,2002,25(4):195-198.
[8] 李飞燕,况九龙.阻塞性睡眠呼吸暂停低通气综合征的异质性及临床分型研究进展[J].山东医药,2016,56(22):98-101.
[9] 刘志强,俞森洋,徐江祥,等.呼吸道正压通气治疗2型糖尿病伴阻塞性睡眠呼吸暂停低通气综合征的临床研究[J].中华保健医学杂志,2012,14(4):286-288.
[10] 闫芳,夏宇,贺家勇,等.阻塞性睡眠呼吸暂停低通气综合征患者气道炎症及气管壁厚度变化[J].中国全科医学,2016,19(5):529-532.
[11] 林娜,李彦如,李天佐,等. 阻塞性睡眠呼吸暂停低通气综合征患者围术期上气道评估[J].首都医科大学学报,2013,34(5):646-650.
[12] 卜小宁,郭兮恒,王辰,等. 阻塞性睡眠呼吸暂停低通气综合征120例临床分析[J].首都医科大学学报,2006,27(1):81-83.
[13] 刘文君,于雪莹,吕丹,等.不同性别阻塞性睡眠呼吸暂停低通气综合征患者与上气道影像学相关性的研究[J].山东大学耳鼻喉眼学报,2017,31(4):54-59.
[14] 肖水芳,贾俊晓,张俊波.阻塞性睡眠呼吸暂停低通气综合征治疗进展[J].临床耳鼻咽喉头颈外科杂志,2016,30(24):1909-1912.
[15] 姜晶,周秀梅.持续气道正压通气在阻塞性睡眠呼吸暂停低通气综合征合并冠心病治疗中的作用观察[J].中国药师,2016,19(6):1105-1107.
[16] Kuang J. Obstructive Sleep Apnea-Hypopnea Syndrome Clinical in Subtypes a Principal Component Analysis-Based Cluster Analysis[J].Chest, 2016,149(4):A566-A566.
[17] 张博薇,彭德昌,粟丽,等.阻塞性睡眠呼吸暂停低通气综合征对上气道咽侧壁及腮腺和颌下脂肪的影响[J].中国全科医学,2017,20(3):314-317.
[18] 王洪洪,李进让,赵鹏举,等.成年阻塞性睡眠呼吸暂停低通气综合征患者体重指数与颈围的性别差异分析[J].临床误诊误治,2016,29(4):94-96.