OSAHS患者舌咽后区MRI测量参数的特征分析
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摘要
目的分析舌咽后区磁共振成像(MRI)测量参数评估阻塞性睡眠呼吸暂停低通气综合症(OSAHS)患者的上气道形态情况,客观地判定上气道阻塞平面及阻塞成因。方法选择2016年5月-2017年12月就诊于湖北民族大学附属民大医院呼吸内科OSAHS的91例患者,按照病情程度分为轻度组(23例)、中度组(23例)、重度组(45例)三组。分析三组患者舌咽后区MRI测量参数。结果重度OSAHS患者体重、BMI、AHI及颌下脂肪厚度明显大于中度、轻度患者(均P <0. 05);重度组OSAHS患者的单一部位阻塞、腭咽合并舌咽部阻塞、软腭肥厚、过长及悬雍垂后坠及腭扁桃体肥大合并舌咽平面狭窄发生率明显高于轻度组、中度组(均P <0. 05);三组OSAHS患者舌咽后区气道各数据(最小截面积、气道横径与矢径、气道前壁、侧壁及后壁)比较,差异有统计学意义(P <0. 05);轻度组OSAHS患者的最小截面积、气道矢径、气道前壁厚度明显大于重度组、中度组,而气道横径、气道侧壁及后壁明显小于重度组、中度组(均P <0. 05)。重度组OSAHS患者AHI值与气道横径、气道后壁软组织厚度呈正相关,与舌咽平面气道矢径呈负相关(均P <0. 05)。结论 OSAHS患者采用MRI影像学测量舌咽后区参数对OSAHS患者的上气道进行形态学分析,可客观评价治疗后气道重塑后改变情况,有重要定位诊断价值。
Objective To analyze the parameters of magnetic resonance imaging( MRI) in the glossopharyngeal region to evaluate the upper airway morphology of patients with obstructive sleep apnea-hypopnea syndrome( OSAHS) and Objective ly determine the upper airway obstruction plane and the cause of obstruction. Methods From May 2016 to December 2017,91 patients with OSAHS in the Department of Respiratory Medicine of Minda Hospital Affiliated to Hubei University for Nationalities were selected and they were classified as the mild group( 23 cases),the moderate group( 23 cases),and the severe group( 45 cases) according to the degree of illness. They were analyzed for MRI parameters in the posterior glossopharyngeal region. Results The body weight,BMI,AHI,and submandibular fat thickness in patients with severe OSAHS were significantly greater than those in moderate and mild patients( all P < 0. 05). In severe OSAHS patients,the incidence of single site obstruction,pharyngeal obstruction,glossopharyngeal obstruction,hypertrophy,hypertrophy,overhang and uvula,and tonsillar hypertrophy with glossopharyngeal plane stenosis were significantly higher than those in the mild and moderate group( all P < 0. 05).The data of airway of glossopharyngeal region of the three groups( minimum cross-sectional area,airway diameter and sagittal diameter,anterior airway wall,lateral wall and posterior wall) were statistically significant( P < 0. 05). The minimum cross-sectional area,airway diameter,and anterior airway wall thickness in the mild OSAHS group were significantly greater than those in the severe and moderate airway groups,while the airway transverse diameter,airway wall,and posterior wall were significantly smaller than those in the severe and moderate groups( P < 0. 05). The AHI value of the severe OSAHS group was positively correlated with the airway diameter and the thickness of the soft tissue in the posterior airway,and negatively correlated with the airway diameter of the glossopharyngeal plane( all P< 0. 05). Conclusion The morphological analysis of upper airway of OSAHS patients by MRI imaging parameters of the glossopharyngeal region can Objectively evaluate the changes after airway remodeling after treatment,which has important diagnostic value for localization.
Objective To analyze the parameters of magnetic resonance imaging( MRI) in the glossopharyngeal region to evaluate the upper airway morphology of patients with obstructive sleep apnea-hypopnea syndrome( OSAHS) and Objective ly determine the upper airway obstruction plane and the cause of obstruction. Methods From May 2016 to December 2017,91 patients with OSAHS in the Department of Respiratory Medicine of Minda Hospital Affiliated to Hubei University for Nationalities were selected and they were classified as the mild group( 23 cases),the moderate group( 23 cases),and the severe group( 45 cases) according to the degree of illness. They were analyzed for MRI parameters in the posterior glossopharyngeal region. Results The body weight,BMI,AHI,and submandibular fat thickness in patients with severe OSAHS were significantly greater than those in moderate and mild patients( all P < 0. 05). In severe OSAHS patients,the incidence of single site obstruction,pharyngeal obstruction,glossopharyngeal obstruction,hypertrophy,hypertrophy,overhang and uvula,and tonsillar hypertrophy with glossopharyngeal plane stenosis were significantly higher than those in the mild and moderate group( all P < 0. 05).The data of airway of glossopharyngeal region of the three groups( minimum cross-sectional area,airway diameter and sagittal diameter,anterior airway wall,lateral wall and posterior wall) were statistically significant( P < 0. 05). The minimum cross-sectional area,airway diameter,and anterior airway wall thickness in the mild OSAHS group were significantly greater than those in the severe and moderate airway groups,while the airway transverse diameter,airway wall,and posterior wall were significantly smaller than those in the severe and moderate groups( P < 0. 05). The AHI value of the severe OSAHS group was positively correlated with the airway diameter and the thickness of the soft tissue in the posterior airway,and negatively correlated with the airway diameter of the glossopharyngeal plane( all P< 0. 05). Conclusion The morphological analysis of upper airway of OSAHS patients by MRI imaging parameters of the glossopharyngeal region can Objectively evaluate the changes after airway remodeling after treatment,which has important diagnostic value for localization.
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.
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[8]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.
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[10]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.
[11]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.
[12]刘川川,黄志纯,杨明,等.阻塞性睡眠呼吸暂停低通气综合征患者上气道MRI测量值与其病情严重程度的相关性研究[J].中国耳鼻咽喉头颈外科,2016,23(4):201-204.
[13]KUANG J L.Obstructive sleep apnea-hypopnea syndrome clinical in subtypes a principal component analysis-based cluster analysis[J].Chest,2016,149(4):A566.
[14]田旭,霍红,李五一,等.内镜检查及上气道压力测定对阻塞性睡眠呼吸暂停低通气综合征患者上气道的评估价值[J].山东大学耳鼻喉眼学报,2016,30(5):29-32.
[15]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.
[16]陆华东,冯学仁,华锋,等.中重度阻塞性睡眠呼吸暂停低通气综合征患者经鼻持续气道正压通气治疗后近期生活质量研究[J].中国临床保健杂志,2016,19(4):349-351.
[17]LIN S,WANG H,LAI W,et al.Pharyngeal constrictor muscle fatty change may contribute to obstructive sleep apnea-hypopnea syndrome:a prospective observational study[J].Acta Otolaryngol,2016,136(12):1285-1290.
[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.
[19]黄祥亚,李雄英,何添标,等.肥胖与阻塞性睡眠呼吸暂停低通气综合征的关系研究[J].实用心脑肺血管病杂志,2016,24(1):79-81.
[2]白志冬,孟宪栋,魏千程,等.阻塞性睡眠呼吸暂停低通气综合征辨证治疗研究概述[J].环球中医药,2016,9(5):641-644.
[3]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.
[4]李铮,鲜军舫,叶京英,等.阻塞性睡眠呼吸暂停低通气综合征患者自然睡眠时上气道及相关结构电影磁共振测量研究[J].中国耳鼻咽喉头颈外科,2016,23(4):196-200.
[5]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.
[6]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.
[7]ZAREMBA S,SHIN C H,HUTTER M M,et al.Continuous positive airway pressure mitigates opioid-induced worsening of sleepdisordered breathing early after bariatric surgery[J].Anesthesiology,2016,125(1):92-104.
[8]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.
[9]GILARDINI L,LOMBARDI C,REDAELLI G,et al.Effect of continuous positive airway pressure in hypertensive patients with obstructive sleep apnea and high urinary metanephrines[J].J Hypertens,2018,36(1):199-204.
[10]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.
[11]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.
[12]刘川川,黄志纯,杨明,等.阻塞性睡眠呼吸暂停低通气综合征患者上气道MRI测量值与其病情严重程度的相关性研究[J].中国耳鼻咽喉头颈外科,2016,23(4):201-204.
[13]KUANG J L.Obstructive sleep apnea-hypopnea syndrome clinical in subtypes a principal component analysis-based cluster analysis[J].Chest,2016,149(4):A566.
[14]田旭,霍红,李五一,等.内镜检查及上气道压力测定对阻塞性睡眠呼吸暂停低通气综合征患者上气道的评估价值[J].山东大学耳鼻喉眼学报,2016,30(5):29-32.
[15]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.
[16]陆华东,冯学仁,华锋,等.中重度阻塞性睡眠呼吸暂停低通气综合征患者经鼻持续气道正压通气治疗后近期生活质量研究[J].中国临床保健杂志,2016,19(4):349-351.
[17]LIN S,WANG H,LAI W,et al.Pharyngeal constrictor muscle fatty change may contribute to obstructive sleep apnea-hypopnea syndrome:a prospective observational study[J].Acta Otolaryngol,2016,136(12):1285-1290.
[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.
[19]黄祥亚,李雄英,何添标,等.肥胖与阻塞性睡眠呼吸暂停低通气综合征的关系研究[J].实用心脑肺血管病杂志,2016,24(1):79-81.