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目的研究急性冠脉综合征(ACS)患者夜间低氧血症对颈动脉粥样硬化斑块的影响。方法将110例ACS患者根据冠脉造影检查和睡眠呼吸监测结果分为三组:ACS组(Ⅰ组,n=37)、ACS合并阻塞型睡眠呼吸暂停低通气综合征-轻度以下夜间低氧血症组(Ⅱ组,n=36)、ACS合并阻塞型睡眠呼吸暂停低通气综合征-中度以上夜间低氧血症亚组(Ⅲ组,n=37)。所有患者均行颈动脉超声检查,对各组间颈动脉内膜中层厚度、斑块数量进行分析,并以Gensini积分比较不同组间冠脉病变严重程度。结果三组在传统冠心病危险因素差异无统计学意义(P>0.05),与Ⅰ组比较,Ⅱ组和Ⅲ组患者颈动脉内膜明显增厚,颈动脉斑块数明显增多(P<0.01);Ⅲ组比Ⅱ组颈动脉内膜明显增厚,总斑块数、软斑块数显著增多(P<0.01),混合斑块数、硬斑块数也明显增多(P<0.05);Ⅱ组和Ⅲ组中颈动脉IMT及斑块数量与夜间最低血氧饱和度成负相关;Ⅱ组与Ⅰ组Gensini积分无统计学差异(P>0.05)。Ⅲ组Gensini积分明显高于Ⅰ组和Ⅱ组(P<0.01)。结论夜间低氧血症对ACS患者颈动脉粥样硬化及斑块的形成可能具有一定作用。
Objective To investigate the effect of nocturnal hypoxemia on carotid artery atherosclerotic plaques in patients with acute coronary syndrome (ACS). Methods One hundred and ten patients with ACS were divided into three groups based on the results of coronary angiography and sleep respiration: ACS group (group Ⅰ, n = 37), ACS with obstructive sleep apnea-hypopnea syndrome (Group Ⅱ, n = 36) and ACS with obstructive sleep apnea-hypopnea syndrome (n = 37) undergoing moderate nocturnal hypoxemia. All patients underwent carotid ultrasonography, carotid artery intima-media thickness and plaque number in each group were analyzed, and the severity of coronary lesions was compared by Gensini score. Results There was no significant difference between the three groups in the risk factors of traditional coronary heart disease (P> 0.05). Compared with group Ⅰ, the carotid intima of patients in group Ⅱ and Ⅲ were significantly thicker and the number of carotid plaques was significantly increased (P <0.01) ). In group Ⅲ, the intima of carotid intima increased significantly, the number of total plaque and soft plaque increased significantly (P <0.01), and the number of mixed plaque and plaque also increased significantly (P <0.05). There was a negative correlation between carotid IMT and plaque number in group Ⅱ and group Ⅲ and night minimum oxygen saturation. There was no significant difference in Gensini score between group Ⅱ and group Ⅰ (P> 0.05). The Gensini score of group Ⅲ was significantly higher than that of group Ⅰ and Ⅱ (P <0.01). Conclusion Nocturnal hypoxemia may play an important role in the development of carotid atherosclerosis and plaque in ACS patients.