阻塞性睡眠呼吸暂停低通气综合征患者血液凝血功能检测分析
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摘要
目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与血液高凝状态的关系。方法选择2017年1月至2018年8月我院收治的OSAHS患者37例,按照OSAHS病情严重程度分为轻度病情组(20例)、中度病情组(9例)、重度病情组(8例)。另选择年龄与OSAHS患者相匹配的50名健康体检者作为对照组,比较四组研究对象的生化指标、凝血功能指标水平。结果对照组、轻度病情组、中度病情组、重度病情组的PT、APTT、INR、TT、FIB、血小板计数比较差异无统计学意义(P> 0. 05);四组研究对象的D-二聚体水平表现为对照组<轻度病情组<中度病情组<重度病情组; OSAHS患者的血小板平均体积大于对照组;四组研究对象的Hb水平表现为对照组<轻度病情组<中度病情组<重度病情组,差异有统计学意义(P <0. 05)。四组研究对象SBP、DBP、TC、TG、HDL-C、LDL-C水平比较差异无统计学意义(P> 0. 05);四组研究对象的BMI表现为对照组<轻度病情组<中度病情组<重度病情组,重度病情组患者的HbA1C、FPG水平均高于其他三组,差异有统计学意义(P <0. 05)。结论与健康体检者比较,OSAHS患者PT、APTT、TT、FIB水平无显著变化,但D-二聚体水平显著升高,血小板平均体积增大,Hb水平升高;重度OSAHS患者的BMI、HbA1C、FPG水平显著升高,可能存在血糖代谢紊乱状况。
Objective To investigate the relationship between obstructive sleep apnea-hypopnea syndrome( OSAHS) and hypercoagulable state. Methods 37 patients with OSAHS admitted to our hospital from January 2017 to August 2018 were divided into mild disease group( 20 cases),moderate disease group( 9 cases) and severe disease group( 8 cases) according to the OSAHS severity. Another 50 healthy cases matched with OSAHS patients in age were selected as the control group. The biochemical indicators and coagulation function levels of the four groups were compared.Results There were no significant differences in PT,APTT,INR,TT,FIB and platelet count among the control group,mild disease group,moderate disease group and severe disease group( P > 0. 05). The D-dimer levels of the four groups were the control group < mild disease group < moderate disease group < severe disease group,the mean platelet volume of OSAHS patients was larger than the control group. The Hb levels of the four groups were the control group < mild disease group < moderate disease group < severe disease group,the difference was statistically significant( P < 0. 05). There were no significant differences in the levels of SBP,DBP,TC,TG,HDL-C and LDL-C among the four groups( P > 0. 05). The BMI of the four groups was the control group < mild disease group < moderate disease group < severe disease group,the HbA1 C and FPG levels in the severe disease group were higher than those in the other three groups,the difference was statistically significant( P < 0. 05). Conclusion Compared with healthy subjects,there were no significant changes in PT,APTT,TT,and FIB levels in OSAHS patients,while the D-dimer levels were significantly elevated,the platelet volume and Hb levels were increased. BMI,HbA1 C,and FPG levels were elevated significantly in patients with severe OSAHS,and there may be disorder of blood glucose metabolism.
Objective To investigate the relationship between obstructive sleep apnea-hypopnea syndrome( OSAHS) and hypercoagulable state. Methods 37 patients with OSAHS admitted to our hospital from January 2017 to August 2018 were divided into mild disease group( 20 cases),moderate disease group( 9 cases) and severe disease group( 8 cases) according to the OSAHS severity. Another 50 healthy cases matched with OSAHS patients in age were selected as the control group. The biochemical indicators and coagulation function levels of the four groups were compared.Results There were no significant differences in PT,APTT,INR,TT,FIB and platelet count among the control group,mild disease group,moderate disease group and severe disease group( P > 0. 05). The D-dimer levels of the four groups were the control group < mild disease group < moderate disease group < severe disease group,the mean platelet volume of OSAHS patients was larger than the control group. The Hb levels of the four groups were the control group < mild disease group < moderate disease group < severe disease group,the difference was statistically significant( P < 0. 05). There were no significant differences in the levels of SBP,DBP,TC,TG,HDL-C and LDL-C among the four groups( P > 0. 05). The BMI of the four groups was the control group < mild disease group < moderate disease group < severe disease group,the HbA1 C and FPG levels in the severe disease group were higher than those in the other three groups,the difference was statistically significant( P < 0. 05). Conclusion Compared with healthy subjects,there were no significant changes in PT,APTT,TT,and FIB levels in OSAHS patients,while the D-dimer levels were significantly elevated,the platelet volume and Hb levels were increased. BMI,HbA1 C,and FPG levels were elevated significantly in patients with severe OSAHS,and there may be disorder of blood glucose metabolism.
引文
[1]中华医学会呼吸病学分会睡眠呼吸障碍学组.阻塞性睡眠呼吸暂停低通气综合征诊治指南(2011年修订版)[J].中华结核和呼吸杂志,2012,35(1):9-12.
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[4]Toraldo DM,De Benedetto M,Scoditti E,et al.Obstructive sleep apnea syndrome:coagulation anomalies and treatment with continuous positive airway pressure[J].Sleep Breath,2016,20(2):457-465.
[5]Borratynska A,Stopyra-Pach K,Fil K,et al.Impaired plasma clot lysis and its determinants in patients with obstructive sleep apnea syndrome[J].Blood Coagul Fibrinolysis,2016,27(8):892-898.
[6]王强.阻塞性睡眠呼吸暂停低通气综合征患者血液流变学指标及D-二聚体抗凝血酶Ⅲ水平变化[J].实用医技杂志,2017,6(6):624-625.
[7]Abdel-Fadeil MR,Abedelhaffez AS,Makhlouf HA,et al.Obstructive sleep apnea:Influence of hypertension on adiponectin,inflammatory markers and dyslipidemia[J].Pathophysiology,2017,24(4):305-315.
[8]Gilardini L,Lombardi C,Redaelli GA,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.
[9]von K¨anel R,Malan NT,Hamer M,et al.Three-year changes of prothrombotic factors in a cohort of South Africans with a high clinical suspicion of obstructive sleep apnea[J].Thromb Haemost,2016,115(1):63-72.
[2]Von K¨anel R,Dimsdale JE.Hemostatic alterations in patients with obstructive sleep apnea and the implications for cardiovascular disease[J].Chest,2003,124(5):1956-1967.
[3]Rangemark C,Hedner JA,Carlson JT,et al.Platelet function and fibrinolytic activity in hypertensive and normotensive sleep apnea patients[J].Sleep,1995,18(3):188-194.
[4]Toraldo DM,De Benedetto M,Scoditti E,et al.Obstructive sleep apnea syndrome:coagulation anomalies and treatment with continuous positive airway pressure[J].Sleep Breath,2016,20(2):457-465.
[5]Borratynska A,Stopyra-Pach K,Fil K,et al.Impaired plasma clot lysis and its determinants in patients with obstructive sleep apnea syndrome[J].Blood Coagul Fibrinolysis,2016,27(8):892-898.
[6]王强.阻塞性睡眠呼吸暂停低通气综合征患者血液流变学指标及D-二聚体抗凝血酶Ⅲ水平变化[J].实用医技杂志,2017,6(6):624-625.
[7]Abdel-Fadeil MR,Abedelhaffez AS,Makhlouf HA,et al.Obstructive sleep apnea:Influence of hypertension on adiponectin,inflammatory markers and dyslipidemia[J].Pathophysiology,2017,24(4):305-315.
[8]Gilardini L,Lombardi C,Redaelli GA,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.
[9]von K¨anel R,Malan NT,Hamer M,et al.Three-year changes of prothrombotic factors in a cohort of South Africans with a high clinical suspicion of obstructive sleep apnea[J].Thromb Haemost,2016,115(1):63-72.