CAJ | 학술논문

目的：观察双水平气道正压通气（ BiPAP）对不同病情程度阻塞性睡眠呼吸暂停综合征（ OSAHS）患者中心动脉压、氨基末端脑钠肽前体（ NT-proBNP）的影响。方法选择172例OSAHS患者（观察组），按照OSAHS的诊断标准和病情严重程度分为3个亚组：轻度亚组58例、中度亚组59例、重度亚组55例，选择同期正常人群60例做为健康对照组。分析比较各组临床特征；观察组患者给予BiPAP治疗30 d后，观察中心收缩压、中心舒张压及NT-proBNP水平的变化；并分析中心收缩压、中心舒张压及NT-proBNP与呼吸暂停低通气指数（ AHI）的相关性。结果（1）与健康对照组比较，OSAHS轻度亚组体质量指数（ BMI）、空腹血糖（ FBG）、糖化血红蛋白（ HbA1c ）、总胆固醇（ TC）、三酰甘油（ TG）、低密度脂蛋白胆固醇（ HDL-C）、高密度脂蛋白胆固醇（ LDL-C）无明显变化（ P ＞0￠．05）；中度亚组、重度亚组的BMI、Glu、HbA1c、TC、TG、LDL-C升高，HDL-C降低（ P ＜0．05），各亚组间比较差异亦有统计学意义（P ＜0．05）。（2）BiPAP治疗30 d后，观察组各亚组中心动脉压及NT-proBNP较健康对照组及本组治疗前均有不同程度的下降（P ＜0．05），且各亚组间治疗后比较差异亦有统计学意义（ P ＜0．05）。（3）观察组患者中心收缩压、中心舒张压、NT-proBNP与AHI呈正相关（ r ＝0．783、r ＝0．634、r ＝0．348， P ＜0．05）。结论 BiPAP能通过降低OS-AHS患者的中心动脉压、NT-proBNP水平，减轻靶器官损害，改善患者预后。
목적：관찰쌍수평기도정압통기（ BiPAP）대불동병정정도조새성수면호흡잠정종합정（ OSAHS）환자중심동맥압、안기말단뇌납태전체（ NT-proBNP）적영향。방법선택172례OSAHS환자（관찰조），안조OSAHS적진단표준화병정엄중정도분위3개아조：경도아조58례、중도아조59례、중도아조55례，선택동기정상인군60례주위건강대조조。분석비교각조림상특정；관찰조환자급여BiPAP치료30 d후，관찰중심수축압、중심서장압급NT-proBNP수평적변화；병분석중심수축압、중심서장압급NT-proBNP여호흡잠정저통기지수（ AHI）적상관성。결과（1）여건강대조조비교，OSAHS경도아조체질량지수（ BMI）、공복혈당（ FBG）、당화혈홍단백（ HbA1c ）、총담고순（ TC）、삼선감유（ TG）、저밀도지단백담고순（ HDL-C）、고밀도지단백담고순（ LDL-C）무명현변화（ P ＞0￠．05）；중도아조、중도아조적BMI、Glu、HbA1c、TC、TG、LDL-C승고，HDL-C강저（ P ＜0．05），각아조간비교차이역유통계학의의（P ＜0．05）。（2）BiPAP치료30 d후，관찰조각아조중심동맥압급NT-proBNP교건강대조조급본조치료전균유불동정도적하강（P ＜0．05），차각아조간치료후비교차이역유통계학의의（ P ＜0．05）。（3）관찰조환자중심수축압、중심서장압、NT-proBNP여AHI정정상관（ r ＝0．783、r ＝0．634、r ＝0．348， P ＜0．05）。결론 BiPAP능통과강저OS-AHS환자적중심동맥압、NT-proBNP수평，감경파기관손해，개선환자예후。
Objective To observe the effect of bi level positive airway pressure ( BiPAP) on central arterial pressure , N-terminal pro brain natriuretic peptide (NT-proBNP) in patients with different severity of obstructive sleep apnea syndrome (OSAHS).Methods One hundred and seventy-two cases of patients with OSAHS (observation group) were enrolled, ac-cording to the diagnostic standard of OSAHS and the severity of the disease , they were divided into 3 subgroups: mild sub-group with 58 cases, moderate subgroup with 59 cases, severe subgroup with 55 cases, 60 normal people in the same period were selected as healthy control group .Comparative analysis of clinical characteristics were performed in each group ;the pa-tients in the observation group were treated with BiPAP , after 30 days, the changes of the level of central systolic pressure , diastolic pressure and NT center proBNP were observed;and the relationship between center systolic pressure , center diastolic pressure, NT /proBNP and apnea hypopnea index (AHI) were analyzed.Results (1) Compared with healthy controls , OS-AHS mild sub group’s body mass index (BMI),fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), total cho-lesterol ( TC) , three glycerol ( TG) , low density lipoprotein ( HDL-C) , high density lipoprotein ( LDL-C) revealed no signifi-cant changes ( P >0.05);moderate subgroup and severe subgroup ’s BMI, Glu, HbA1c, TC, TG, LDL-C were increased, HDL-C were decreased ( P <0.05), the differences between each subgroup also have statistical significance ( P <0.05). (2) 30 d after BiPAP treatment, central arterial pressure and NT-proBNP in each subgroup of the observation group were de-creased compared with healthy controls group and before treatment ( P <0.05), and among these subgroups , after treatment, differences also have statistical significance ( P <0.05).(3) Central systolic pressure, center diastolic pressure, NT-proB-NP in the observation group was positively correlated with AHI ( r =0.783, r =0.634, r =0.348, P <0.05).Conclusion Through lower the central arterial pressure , NT-proBNP level in patients with OSAHS , BiPAP reduce the target organ damage;improve the prognosis .