中华医学超声杂志（电子版）
中華醫學超聲雜誌（電子版）
중화의학초성잡지（전자판）
CHINESE JOURNAL OF MEDICAL ULTRASOUND(ELECTRONICAL VISION)
2015年
6期
438-445
,共8页
张玉萍%张莉%马春梅%肖晓刚%任华%崔美月
張玉萍%張莉%馬春梅%肖曉剛%任華%崔美月
장옥평%장리%마춘매%초효강%임화%최미월
超声心动图%阻塞性睡眠呼吸暂停综合征%冠状动脉血流储备
超聲心動圖%阻塞性睡眠呼吸暫停綜閤徵%冠狀動脈血流儲備
초성심동도%조새성수면호흡잠정종합정%관상동맥혈류저비
Echocardiography%Obstructive sleep apnea syndrome%Coronaryfl ow reserve
目的：探讨经胸超声心动图冠状动脉血流成像技术评估阻塞性睡眠呼吸暂停综合征（OSA）患者冠状动脉血流储备（CFR）的价值。方法选择2010年3月至2013年12月航天七三一医院收治的OSA患者50例。其中5≤呼吸暂停低通气指数（AHI）<20，18例；20≤AHI<40，16例；AHI>40，16例。采用经胸超声心动图冠状动脉血流成像技术检测静息状态下冠状动脉左前降支远端舒张期最大峰值血流速度（PDV)、舒张期平均血流速度（MDV）及注射三磷酸腺苷（ATP）后PDV、MDV及CFR。选择40名健康体检者作为健康对照组。采用t检验比较OSA患者与健康对照组PDV、MDV、CFR差异；采用单因素方差分析比较不同AHI的OSA患者PDV、MDV、CFR差异，进一步组间两两比较采用SNK-q检验；采用t检验比较OSA患者、健康对照组、不同AHI的OSA患者静息状态下与ATP负荷状态下PDV、MDV差异。结果静息状态下，全部受检者均获得满意的冠状动脉左前降支远端血流及多普勒频谱。静脉注射ATP后，健康对照组PDV、MDV分别为（92.78±7.68）、（85.93±6.98）cm/s，高于静息状态下的（28.09±4.55）、（21.76±5.09）cm/s，且差异均有统计学意义（t值分别为49.687、58.259，均P<0.001）；静脉注射ATP后，OSA患者PDV、MDV分别为（82.73±6.91）、（77.39±6.73）cm/s，高于静息状态下的（29.93±3.66）、（22.28±4.15）cm/s，且差异均有统计学意义（t值分别为55.381、47.700，均P<0.001）。静息状态下，OSA患者与健康对照组PDV、MDV差异均无统计学意义；静脉注射ATP后，OSA患者PDV、MDV均高于健康对照组，且差异均有统计学意义（t值分别为6.524、5.884，均P<0.01）。静息状态下，不同AHI的OSA患者PDV、MDV差异均无统计学意义；静脉注射ATP后，不同AHI的OSA患者PDV、MDV均较静息状态下增加，且差异均有统计学意义（5≤AHI<20：t值分别为-32.903、-32.771，均P=0.000；20≤AHI<40：t值分别为-37.122、-32.623，均P=0.000；AHI>40：t值分别为-28.197、-20.184，均P=0.000）；且AHI>40的OSA患者PDV、MDV均小于5≤AHI<20、20≤AHI<40的OSA患者，且差异均有统计学意义（PDV：q值分别为21.048、15.667，均P<0.05；MDV：q值分别为12.958、18.182，均P<0.05），但5≤AHI<20的OSA患者与20≤AHI<40的OSA患者PDV、MDV差异均无统计学意义。OSA患者CFRmax、CFRmean均较健康对照组降低，且差异均有统计学意义（t值分别为5.310、6.430，均P=0.000）。不同AHI的OSA患者CFRmax、CFRmean差异均有统计学意义，而且随着疾病程度加重呈递减趋势；且5≤AHI<20的OSA患者CFRmax、CFRmean均大于20≤AHI<40、AHI>40的OSA患者，且差异均有统计学意义（CFRmax：q值分别为2.889、4.142，均P<0.05；CFRmean：q值分别为3.080、4.204，均P<0.05），但20≤AHI<40的OSA患者与AHI>40的OSA患者CFRmax、CFRmean差异均无统计学意义。结论经胸超声心动图冠状动脉血流成像技术结合ATP能够无创性评价OSA患者CRF的变化，能较为敏感地检测到冠状动脉早期病变及冠状动脉微循环功能异常，可用于患者的长期追踪随访以及药物或手术疗效的判断，具有较高的临床实用价值。
目的：探討經胸超聲心動圖冠狀動脈血流成像技術評估阻塞性睡眠呼吸暫停綜閤徵（OSA）患者冠狀動脈血流儲備（CFR）的價值。方法選擇2010年3月至2013年12月航天七三一醫院收治的OSA患者50例。其中5≤呼吸暫停低通氣指數（AHI）<20，18例；20≤AHI<40，16例；AHI>40，16例。採用經胸超聲心動圖冠狀動脈血流成像技術檢測靜息狀態下冠狀動脈左前降支遠耑舒張期最大峰值血流速度（PDV)、舒張期平均血流速度（MDV）及註射三燐痠腺苷（ATP）後PDV、MDV及CFR。選擇40名健康體檢者作為健康對照組。採用t檢驗比較OSA患者與健康對照組PDV、MDV、CFR差異；採用單因素方差分析比較不同AHI的OSA患者PDV、MDV、CFR差異，進一步組間兩兩比較採用SNK-q檢驗；採用t檢驗比較OSA患者、健康對照組、不同AHI的OSA患者靜息狀態下與ATP負荷狀態下PDV、MDV差異。結果靜息狀態下，全部受檢者均穫得滿意的冠狀動脈左前降支遠耑血流及多普勒頻譜。靜脈註射ATP後，健康對照組PDV、MDV分彆為（92.78±7.68）、（85.93±6.98）cm/s，高于靜息狀態下的（28.09±4.55）、（21.76±5.09）cm/s，且差異均有統計學意義（t值分彆為49.687、58.259，均P<0.001）；靜脈註射ATP後，OSA患者PDV、MDV分彆為（82.73±6.91）、（77.39±6.73）cm/s，高于靜息狀態下的（29.93±3.66）、（22.28±4.15）cm/s，且差異均有統計學意義（t值分彆為55.381、47.700，均P<0.001）。靜息狀態下，OSA患者與健康對照組PDV、MDV差異均無統計學意義；靜脈註射ATP後，OSA患者PDV、MDV均高于健康對照組，且差異均有統計學意義（t值分彆為6.524、5.884，均P<0.01）。靜息狀態下，不同AHI的OSA患者PDV、MDV差異均無統計學意義；靜脈註射ATP後，不同AHI的OSA患者PDV、MDV均較靜息狀態下增加，且差異均有統計學意義（5≤AHI<20：t值分彆為-32.903、-32.771，均P=0.000；20≤AHI<40：t值分彆為-37.122、-32.623，均P=0.000；AHI>40：t值分彆為-28.197、-20.184，均P=0.000）；且AHI>40的OSA患者PDV、MDV均小于5≤AHI<20、20≤AHI<40的OSA患者，且差異均有統計學意義（PDV：q值分彆為21.048、15.667，均P<0.05；MDV：q值分彆為12.958、18.182，均P<0.05），但5≤AHI<20的OSA患者與20≤AHI<40的OSA患者PDV、MDV差異均無統計學意義。OSA患者CFRmax、CFRmean均較健康對照組降低，且差異均有統計學意義（t值分彆為5.310、6.430，均P=0.000）。不同AHI的OSA患者CFRmax、CFRmean差異均有統計學意義，而且隨著疾病程度加重呈遞減趨勢；且5≤AHI<20的OSA患者CFRmax、CFRmean均大于20≤AHI<40、AHI>40的OSA患者，且差異均有統計學意義（CFRmax：q值分彆為2.889、4.142，均P<0.05；CFRmean：q值分彆為3.080、4.204，均P<0.05），但20≤AHI<40的OSA患者與AHI>40的OSA患者CFRmax、CFRmean差異均無統計學意義。結論經胸超聲心動圖冠狀動脈血流成像技術結閤ATP能夠無創性評價OSA患者CRF的變化，能較為敏感地檢測到冠狀動脈早期病變及冠狀動脈微循環功能異常，可用于患者的長期追蹤隨訪以及藥物或手術療效的判斷，具有較高的臨床實用價值。
목적：탐토경흉초성심동도관상동맥혈류성상기술평고조새성수면호흡잠정종합정（OSA）환자관상동맥혈류저비（CFR）적개치。방법선택2010년3월지2013년12월항천칠삼일의원수치적OSA환자50례。기중5≤호흡잠정저통기지수（AHI）<20，18례；20≤AHI<40，16례；AHI>40，16례。채용경흉초성심동도관상동맥혈류성상기술검측정식상태하관상동맥좌전강지원단서장기최대봉치혈류속도（PDV)、서장기평균혈류속도（MDV）급주사삼린산선감（ATP）후PDV、MDV급CFR。선택40명건강체검자작위건강대조조。채용t검험비교OSA환자여건강대조조PDV、MDV、CFR차이；채용단인소방차분석비교불동AHI적OSA환자PDV、MDV、CFR차이，진일보조간량량비교채용SNK-q검험；채용t검험비교OSA환자、건강대조조、불동AHI적OSA환자정식상태하여ATP부하상태하PDV、MDV차이。결과정식상태하，전부수검자균획득만의적관상동맥좌전강지원단혈류급다보륵빈보。정맥주사ATP후，건강대조조PDV、MDV분별위（92.78±7.68）、（85.93±6.98）cm/s，고우정식상태하적（28.09±4.55）、（21.76±5.09）cm/s，차차이균유통계학의의（t치분별위49.687、58.259，균P<0.001）；정맥주사ATP후，OSA환자PDV、MDV분별위（82.73±6.91）、（77.39±6.73）cm/s，고우정식상태하적（29.93±3.66）、（22.28±4.15）cm/s，차차이균유통계학의의（t치분별위55.381、47.700，균P<0.001）。정식상태하，OSA환자여건강대조조PDV、MDV차이균무통계학의의；정맥주사ATP후，OSA환자PDV、MDV균고우건강대조조，차차이균유통계학의의（t치분별위6.524、5.884，균P<0.01）。정식상태하，불동AHI적OSA환자PDV、MDV차이균무통계학의의；정맥주사ATP후，불동AHI적OSA환자PDV、MDV균교정식상태하증가，차차이균유통계학의의（5≤AHI<20：t치분별위-32.903、-32.771，균P=0.000；20≤AHI<40：t치분별위-37.122、-32.623，균P=0.000；AHI>40：t치분별위-28.197、-20.184，균P=0.000）；차AHI>40적OSA환자PDV、MDV균소우5≤AHI<20、20≤AHI<40적OSA환자，차차이균유통계학의의（PDV：q치분별위21.048、15.667，균P<0.05；MDV：q치분별위12.958、18.182，균P<0.05），단5≤AHI<20적OSA환자여20≤AHI<40적OSA환자PDV、MDV차이균무통계학의의。OSA환자CFRmax、CFRmean균교건강대조조강저，차차이균유통계학의의（t치분별위5.310、6.430，균P=0.000）。불동AHI적OSA환자CFRmax、CFRmean차이균유통계학의의，이차수착질병정도가중정체감추세；차5≤AHI<20적OSA환자CFRmax、CFRmean균대우20≤AHI<40、AHI>40적OSA환자，차차이균유통계학의의（CFRmax：q치분별위2.889、4.142，균P<0.05；CFRmean：q치분별위3.080、4.204，균P<0.05），단20≤AHI<40적OSA환자여AHI>40적OSA환자CFRmax、CFRmean차이균무통계학의의。결론경흉초성심동도관상동맥혈류성상기술결합ATP능구무창성평개OSA환자CRF적변화，능교위민감지검측도관상동맥조기병변급관상동맥미순배공능이상，가용우환자적장기추종수방이급약물혹수술료효적판단，구유교고적림상실용개치。
ObjectiveTo estimate the value of transthoracic coronary flow Doppler imaging to detect coronary flow reserve (CFR) changes in patient with obstructive sleep apnea syndrome (OSA). Methods Fifty patients with OSA who hospitalized or were outpatient in Aerospace 731 Hospital during the period of 2010 March to 2013 December were enrolled in this study and were divided into three groups according to apnea hypopnea index (AHI). Eighteen cases of patients which AHI was greater than 5 and less than 20 were defi ned as mild group, 16 cases of patients which AHI was more than 20 and less than 40 were defi ned as middle group, 16 cases of patients which AHI was greater than 40 were defi ned as severe group. The diastolic peak velocity (PDV) and meanfl ow velocity (MDV) of the distance segment of left anterior descending coronary (LAD) were measured by transthoracic echocardiography at rest and after intravenous infusion of adenosine triphosphate (ATP). Meanwhile, CFR was calculated. Forty healthy persons were chosen as control group. Thettest was used to compare the difference of PDV, MDV and CFR between OSA group and healthy controls. The single factor analysis of variance was used to compare the difference of PDV, MDV and CFR in patients with different AHI. SNK -q test was used to compare in different OSA groups. Thet test was used to compare the difference of PDV, MDV among OSA group, healthy control and OSA groups with different AHI at rest and after intravenous infusion of ATP.ResultsCoronaryfl ow velocity Doppler signals were successfully obtained in all the groups. PDV ([92.78±7.68] cm/s) and MDV ([85.93±6.98] cm/s) after intravenous infusion of ATP in control group were significant higher than those at rest ([28.09±4.55] cm/s and [21.76±5.09] cm/s) (t=49.687 and 58.259, bothP<0.001). PDV ([82.73±6.91] cm/s) and MDV ([77.39±6.73] cm/s) after intravenous infusion of ATP in OSA group were signifi cant higher than those at rest ([29.93±3.66] cm/s and [22.28±4.15] cm/s) (t=55.381 and 47.700, bothP<0.001). There was no statistically signifi cant difference between PDV and MDV at rest in OSA group and control group. The difference of PDV and MDV between OSA group and normal group was statistically signifi cant after intravenous infusion of ATP (t=6.524 and 5.884, bothP<0.01). There was no statistically signifi cant difference between OSA groups with different AHI at rest. There were statistically signifi cant difference between OSA groups with different AHI after intravenous infusion of ATP (5≤AHI<20:t=-32.903 and-32.771, both P=0.000; 20≤AHI<40:t=-37.122 and-32.623, bothP=0.000; AHI>40:t=-28.197 and-20.184, both P=0.000). PDV and MDV of patients with AHI>40 were less than those of patients with 5≤AHI <20 and 20≤AHI<40 and the differences were statistically signifi cant (PDV:q=21.048 and 15.667, bothP<0.05; MDV:q=12.958 and 18.182, bothP<0.05). However, the differences of PDV and MDV was not statistically signifi cant between patients with 5≤AHI<20 and patients with 20≤AHI<40.The CFRmax and CFRmean in OSA group were lower than those in control group (t=5.310 and 6.430, bothP=0.000). There were statistically signifi cant difference for CFRmax and CFRmean in patients with different AHI and the difference decreased with severity of OSA increased. The CFRmax and CFRmean in patients with 5≤AHI<20 were higher than those in patients with 20≤AHI<40 and AHI>40 (CFRmax:q=2.889 and 4.142, bothP<0.05; CFRmean:q=3.080 and 4.204, bothP<0.05). There was no statistical signifi cant difference for CFRmax and CFRmean between patients with 20≤AHI<40 and patients with AHI>40.ConclusionsIn patients with obstructive sleep apnea syndrome, transthoracic coronaryfl ow imaging combined with intravenous infusion of adenosine triphosphate shows impaired in CFR. It means the patients with OSA have a coronary artery microcirculation impairment in early stage. Assessing CFR in the patients with OSA is of important clinical value for the evaluation of treatment effective of medicine and surgery and follow-up.
