阻塞性睡眠呼吸暂停低通气综合征患者的眼血流变化
조새성수면호흡잠정저통기종합정환자적안혈류변화
Changes of ophthalmic blood flow in obstructive sleep apnea-hypopnea syndrome
  • 万方数据
    中华眼科杂志 중화안과잡지
    Chinese Journal of Ophthalmology
    2012年 7期 631-636 ,共6页

    张兰兰%宋璐%范艳锋%王蓓%刘卓拉

    장란란%송로%범염봉%왕배%류탁랍

    睡眠呼吸暂停,阻塞性%眼动脉%睫状动脉%视网膜动脉%血流速度 睡眠呼吸暫停,阻塞性%眼動脈%睫狀動脈%視網膜動脈%血流速度
    수면호흡잠정,조새성%안동맥%첩상동맥%시망막동맥%혈류속도
    Sleep,obstructive%Ophthalmic artery%Ciliary arteries%Retinal artery%Blood flow velocity
    目的 观察阻塞性睡眠呼吸暂停低通气综合征(OSAS)患者的眼动脉、睫状后动脉及视网膜中央动脉的血流参数变化及其对血流的影响.方法 病例对照研究.选取2010年10至12月,由体检中心确定的健康超体重者15例作为正常对照组；选取2010年6至12月由睡眠监测中心诊断的42例OSAS患者,分为轻度OSAS组14例,中重度OSAS组28例；进行病例对照研究.所有受试者均行整夜多导睡眠监测；监测次日上午行潮气末二氧化碳、眼压及眼部超声多普勒检查.受试者眼部血管内径和血流速度用中位数(最大值,最小值)表示,采用Kruskal-Wallis法检验,组间两两比较采用Bonferroni检验法(仅提供D值)；患者眼血流速度与多导睡眠监测指标的相关性采用偏相关分析法.结果 中重度OSAS患者组:眼动脉内径为0.08 (0.15,0.06)cm,显著低于对照组0.15 (0.26,0.11)cm,差异有统计学意义(P=0.000)；睫状后动脉内径和视网膜中央动脉收缩期血流速度分别为0.10(0.13,0.07)cm和16.50(19.40,13.10) cm/s,显著高于对照组0.05(0.09,0.04)cm和11.30(16.70,8.20) cm/s,差异有统计学意义(PCV内径:P=0.000,视网膜中央动脉收缩期血流速度:P=0.001).视网膜中央动脉舒张末期血流速度:轻度OSAS患者组为7.00(8.30,4.50) cm/s,中重度OSAS患者组为8.90(9,90,5.10)cm/s,对照组为5.50(7.40,3.40) cm/s；组间舒张末期血流速度差异有统计学意义(x2=14.45,P＜0.05).中重度组睫状后动脉收缩期和舒张末期血流速度分别为32.50(43.10,19.10)cm/s和12.80(15.20,5.70) cm/s,显著高于对照组22.60(32.20,12.40) cm/s和7.20( 11.20,3.90)cm/s,也高于轻度组24.00(30.70,13.30) cm/s和8.00(9.90,3.90) cm/s,差异均有统计学意义(睫状后动脉收缩期血流速度:P=0.000,0.002；睫状后动脉舒张末期血流速度:P=0.000,0.0101).眼动脉、睫状后动脉血管内径均与潮气末CO2相关(r=-0.41,-0.34；P＜0.05)；视网膜中央动脉收缩期血流速度与最低血氧饱和度相关(r=-0.37,P＜0.05)；视网膜中央动脉舒张末期血流速度与潮气末二氧化碳、平均血氧饱和度相关(r=0.57,-0.39;P ＜0.05),睫状后动脉收缩期血流速度与最低血氧饱和度、微觉醒指数相关(r=-0.34,0.56；P＜0.05)；睫状后动脉舒张末期血流速度与最低血氧饱和度和微觉醒指数相关(r=-0.29,0.61；P＜0.05).结论 OSAS患者的眼动脉、睫状后动脉、视网膜中央动脉的管腔内径和血液流速均发生改变,其眼部血管自主调节功能较正常对照者减弱.
    목적 관찰조새성수면호흡잠정저통기종합정(OSAS)환자적안동맥、첩상후동맥급시망막중앙동맥적혈류삼수변화급기대혈류적영향.방법 병례대조연구.선취2010년10지12월,유체검중심학정적건강초체중자15례작위정상대조조；선취2010년6지12월유수면감측중심진단적42례OSAS환자,분위경도OSAS조14례,중중도OSAS조28례；진행병례대조연구.소유수시자균행정야다도수면감측；감측차일상오행조기말이양화탄、안압급안부초성다보륵검사.수시자안부혈관내경화혈류속도용중위수(최대치,최소치)표시,채용Kruskal-Wallis법검험,조간량량비교채용Bonferroni검험법(부제공D치)；환자안혈류속도여다도수면감측지표적상관성채용편상관분석법.결과 중중도OSAS환자조:안동맥내경위0.08 (0.15,0.06)cm,현저저우대조조0.15 (0.26,0.11)cm,차이유통계학의의(P=0.000)；첩상후동맥내경화시망막중앙동맥수축기혈류속도분별위0.10(0.13,0.07)cm화16.50(19.40,13.10) cm/s,현저고우대조조0.05(0.09,0.04)cm화11.30(16.70,8.20) cm/s,차이유통계학의의(PCV내경:P=0.000,시망막중앙동맥수축기혈류속도:P=0.001).시망막중앙동맥서장말기혈류속도:경도OSAS환자조위7.00(8.30,4.50) cm/s,중중도OSAS환자조위8.90(9,90,5.10)cm/s,대조조위5.50(7.40,3.40) cm/s；조간서장말기혈류속도차이유통계학의의(x2=14.45,P＜0.05).중중도조첩상후동맥수축기화서장말기혈류속도분별위32.50(43.10,19.10)cm/s화12.80(15.20,5.70) cm/s,현저고우대조조22.60(32.20,12.40) cm/s화7.20( 11.20,3.90)cm/s,야고우경도조24.00(30.70,13.30) cm/s화8.00(9.90,3.90) cm/s,차이균유통계학의의(첩상후동맥수축기혈류속도:P=0.000,0.002；첩상후동맥서장말기혈류속도:P=0.000,0.0101).안동맥、첩상후동맥혈관내경균여조기말CO2상관(r=-0.41,-0.34；P＜0.05)；시망막중앙동맥수축기혈류속도여최저혈양포화도상관(r=-0.37,P＜0.05)；시망막중앙동맥서장말기혈류속도여조기말이양화탄、평균혈양포화도상관(r=0.57,-0.39;P ＜0.05),첩상후동맥수축기혈류속도여최저혈양포화도、미각성지수상관(r=-0.34,0.56；P＜0.05)；첩상후동맥서장말기혈류속도여최저혈양포화도화미각성지수상관(r=-0.29,0.61；P＜0.05).결론 OSAS환자적안동맥、첩상후동맥、시망막중앙동맥적관강내경화혈액류속균발생개변,기안부혈관자주조절공능교정상대조자감약.
    Objective To observe the ophthalmic artery (OA),central retinal artery (CRA) and posterior ciliary artery ( PCA ) blood flow and the changes of eye vascular auto-regulation in patients with obstructive sleep apnea-hypopnea syndrome (OSAS).Methods It was a case-control study.Fifteen health overweight male adult (as normal control ) and 42 patients with OSAS were randomly selected from examination center and sleep detection center,respectively.The OSAS patients were divided into mild (14 patients) and moderate and severe (28 patients) groups based on the apnea-hypopnea index (AHI).All subjects filled the sleep questionnaire and carried out polysomnogram monitoring all night for at least 7 hours.Fasting peripheral venous blood was collected at 7 AM on next day.The end-tidal CO2 ( ETCO2 ),intraocular pressure and color doppler sonography were examined next day to record the data in the inspection process before and after Mueller maneuver.Doppler ultrasound measurement of ocular blood flow diameter and blood flow velocity values were described in the median (max,min) and compared with Kruskal-Wallis test.And then two groups were compared with Bonferroni t test.Ocular blood flow velocity of patients with OSAS and PSG monitoring indicators were analyzed using partial correlation analysis.Results OA inner diameter in moderate and severe OSAS group [0.08 (0.15,0.06) cm]was lower than that in healthy control [ 0.15 (0.26,0.11 ) cm ]and the difference was statistically significant ( P =0.000 ).PCA inner diameter in moderate and severe OSAS group [0.10 (0.13,0.07 ) cm]were higher than that in healthy controls [0.05 (0.09,0.04) cm].CRA peak systolic velocity (PSV) in moderate and severe OSAS group [ 16.50 (19.40,13.10) cm/s ]was greater than that in healthy controls [ 11.30 ( 16.70,8.20 ) cm/s ].The differences between these two groups were statistically significant ( PCA inner diameter:P =0.000,CRA-PSV:P=0.001).The difference of CRA end diastolic velocity (EDV) between the moderate and severe group [ 8.90 ( 9.90,5.10 ) crm/s ],mild group [ 7.00 ( 8.30,4.50 ) cm/s ]and healthy control group [5.50 (7.40,3.40) cm/s]was statistically significant ( x2 =14.45,P ＜0.05).PCA-PSV [32.50(43.10,19.10) cm/s]and PCA-EDV [ 12.80 ( 15.20,5.70) cm/s]in the moderate and severe group were higher than those in healthy control group [ 22.60 ( 32.20,12.40 ) cm/s ]and [ 7.20 ( 11.20,3.90) cm/s],as well as those in the mild group [24.00 (30.70,13.30) cm/s]and [8.00 (9.90,3.90)cm/s].These differences were statistically significant ( PCA-PSV:P =0.000,0.002; PCA-EDV:P =0.000,0.001 ).The diameter of OA and PCA correlated negatively with ETCO2 ( r =-0.41,-0.34 ; P ＜0.05 ) ; CRA-PSV was correlated with SaO2min ( r =-0.37,P ＜ 0.05 ).CRA-EDV was correlated with ETCO2 and SaO2 mean ( r =0.57,-0.39 ; P ＜ 0.05 ).PCA-PSV was correlated with SaO2 min and MAI (r=-0.34,0.56; P ＜0.05).PCA-EDV was correlated SaO2min and MAI (r=-0.29,0.61; P＜0.05).Conclusions The diameter and blood flow of OA,PCA and CRA change in OSAS patients.Compared with non-OSAS patients,the autoregulation function of PCA and CRA is weakened in OSAS patients.
    원문보기 원문다운로드 사이트로이동
저자의 최근 논문