Hcy联合颈动脉超声在脑卒中高危人群OSAHS筛查中的作用
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摘要
目的探讨血浆同型半胱氨酸(Hcy)检测联合颈动脉超声检测在脑卒中高危人群阻塞性睡眠呼吸暂停低通气综合征(OSAHS)筛查中的应用价值。方法选取进行脑卒中筛查的夜间睡眠过程打鼾患者200例,根据多导睡眠监测结果,将患者分为OSAHS组和对照组。比较两组人群的临床特征、血浆Hcy水平、颈动脉超声检查指标,统计学分析联合检测血浆Hcy和颈动脉超声对脑卒中高危人群OSAHS的诊断价值。结果入组人群的OSAHS发病率为46.50%,两组患者临床特征比较,差异无统计学意义(P>0.05)。OSAHS组患者血浆Hcy水平显著高于对照组(P<0.05)。经颈动脉超声检查,OSAHS组患者内膜-中膜厚度(IMT)和颈动脉粥样斑块比例显著高于对照组(P<0.05)。OSAHS组患者血浆Hcy与IMT厚度呈正相关(r=0.65,P<0.05)。血浆Hcy 24.045μmol/L为诊断脑卒中高危人群OSAHS的最佳阈值,其曲线下面积为0.730,特异性为68.2%,灵敏度为66.7%。而颈动脉超声检测IMT 0.824 mm为最佳阈值,曲线下面积0.970,特异性为90.3%,灵敏度为91.6%。血浆Hcy联合IMT诊断OSAHS的灵敏度为60.21%,特异性为97.20%,假阳性率为2.89%。结论血浆Hcy联合颈动脉超声可作为脑卒中高危人群中OSAHS的筛查手段,具有较高特异性。
Aim To study the dynamics of homocysteine( Hcy) and carotid atherosclerosis in patients with obstructive sleep apnea-hypopnea syndrome( OSAHS) and the high risk of stroke,and to investigate the clinic application of the combination of Hcy and carotid ultrasound in screening OSAHS in population with the high risk of stroke. Methods Select a total of 200 patients who were found to be snoring during night sleep with the screening of stroke. Analyze the diagnostic value of the combination of plasma Hcy and carotid artery ultrasound for OSAHS in patients with high risk of stroke. Results The incidence of OSAHS in this study was 46. 50%. There was no significant difference in clinic characteristics between two groups( P>0.05). Plasma Hcy level in OSAHS group was significantly higher than the control groups( P<0.05). According to carotid ultrasound,intima-media thickness( IMT) in OSAHS group was much thicker than the control group( P<0.05). The positive correlation between plasma Hcy and IMT was observed in OSAHS group( r= 0.65,P<0.05). The cut-off value of plasma Hcy in OSAHS diagnosis was 24.045 μmol/L,and its area under curve( AUC) was 0.730. The specificity and sensitivity were 68.2% and 66.7%,respectively. 0.824 mm of IMT under carotid ultrasound was the best in OSAHS diagnosis,with AUC of 0.970,the specificity of 90.3% and the sensitivity of 91.6%.The sensitivity of the combination of plasma Hcy and IMT in OSAHS diagnosis was 60.21% and the specificity and false positive rate were 97.20% and 2.89%. Conclusion Plasma Hcy combined with carotid ultrasound could be applied as a screening method of OSAHS in population with high risk of stroke,which has high specificity.
Aim To study the dynamics of homocysteine( Hcy) and carotid atherosclerosis in patients with obstructive sleep apnea-hypopnea syndrome( OSAHS) and the high risk of stroke,and to investigate the clinic application of the combination of Hcy and carotid ultrasound in screening OSAHS in population with the high risk of stroke. Methods Select a total of 200 patients who were found to be snoring during night sleep with the screening of stroke. Analyze the diagnostic value of the combination of plasma Hcy and carotid artery ultrasound for OSAHS in patients with high risk of stroke. Results The incidence of OSAHS in this study was 46. 50%. There was no significant difference in clinic characteristics between two groups( P>0.05). Plasma Hcy level in OSAHS group was significantly higher than the control groups( P<0.05). According to carotid ultrasound,intima-media thickness( IMT) in OSAHS group was much thicker than the control group( P<0.05). The positive correlation between plasma Hcy and IMT was observed in OSAHS group( r= 0.65,P<0.05). The cut-off value of plasma Hcy in OSAHS diagnosis was 24.045 μmol/L,and its area under curve( AUC) was 0.730. The specificity and sensitivity were 68.2% and 66.7%,respectively. 0.824 mm of IMT under carotid ultrasound was the best in OSAHS diagnosis,with AUC of 0.970,the specificity of 90.3% and the sensitivity of 91.6%.The sensitivity of the combination of plasma Hcy and IMT in OSAHS diagnosis was 60.21% and the specificity and false positive rate were 97.20% and 2.89%. Conclusion Plasma Hcy combined with carotid ultrasound could be applied as a screening method of OSAHS in population with high risk of stroke,which has high specificity.
引文
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[13] Lin SH,Branson C,Leung J,et al.Oximetry as an accurate tool for identifying moderate to severe sleep apnea in patients with acute stroke[J].J Clin Sleep Med,2018,14(12):2065-2073.
[14] Li J,Yu LQ,Jiang M,et al.Homocysteine level in patients with obstructive sleep apnea/hypopnea syndrome and the impact of continuous positive airway pressure treatment[J].Adv Clin Exp Med,2018,27(11):1549-1554.
[15] Liu DS,Wang SL,Li JM,et al.Allicin improves carotid artery intima-media thickness in coronary artery disease patients with hyperhomocysteinemia[J].Exp Ther Med,2017,14(2):1722-1726.
[2] Huhtakangas JK,Saaresranta T,Bloigu R,et al.The evolution of sleep apnea six months after acute ischemic stroke and thrombolysis[J].J Clin Sleep Med,2018,14(12):2005-2011.
[3] Zhang J,Song Y,Ji Y,et al.Correlation between coronary artery disease and obstructive sleep apnea syndrome and analysis of risk factors[J].Exp Ther Med,2018,15(6):4771-4776.
[4] Yeh JK,Chen CC,Hsieh MJ,et al.Impact of homocysteine level on long-term cardiovascular outcomes in patients after coronary artery stenting[J].J Atheroscler Thromb,2017,24(7):696-705.
[5] Bryniarski KL,Tokarek T,Bryk T,et al.Intima-media thickness and ankle-brachial index are correlated with the extent of coronary artery disease measured by the SYNTAX score[J].Postepy Kardiol Interwencyjnej,2018,14(1):52-58.
[6] Chang LK.Overnight pulse oximetry for obstructive sleep apnea screening among patients with snoring in primary care setting:clinical case report[J].J Family Med Prim Care,2018,7(5):1086-1089.
[7] Ragia G,Archontogeorgis K,Simmaco M,et al.Genetics of obstructive sleep apnea:vitamin D receptor gene variation affects both vitamin D serum concentration and disease susceptibility[J].OMICS,2019,23(1):45-53.
[8] Alshehri MA,Alharthi SR,Alsuwat AA,et al.Clinical characteristics of type 2 diabetics who are at high risk for obstructive sleep apnea[J].Med Arch,2018,72(4):249-252.
[9] Lu SS,Xie J,Su CQ,et al.Plasma homocysteine levels and intracranial plaque characteristics:association and clinical relevance in ischemic stroke[J].BMC Neurol,2018,18(1):200.
[10] Qaism M,BukhariSA,Ghani MJ,et al.Relationship of oxidative stress with elevated level of DNA damage and homocysteine in cardiovascular disease patients[J].Pak J Pharm Sci,2016,29(6 Suppl):2297-2302.
[11] Wu N,Chen X,Li M,et al.Predicting obstructive coronary artery disease using carotid ultrasound parameters:a nomogram from a large real-world clinical data[J].Eur J Clin Invest,2018,48(8):e12956.
[12] Baniak LM,Chasens ER,Luyster FS,et al.Obstructive sleep apnea and self-reported functional impairment in revascularized patients with coronary artery disease in the RICCADSA trial[J].Sleep Breath,2018,22(4):1169-1177.
[13] Lin SH,Branson C,Leung J,et al.Oximetry as an accurate tool for identifying moderate to severe sleep apnea in patients with acute stroke[J].J Clin Sleep Med,2018,14(12):2065-2073.
[14] Li J,Yu LQ,Jiang M,et al.Homocysteine level in patients with obstructive sleep apnea/hypopnea syndrome and the impact of continuous positive airway pressure treatment[J].Adv Clin Exp Med,2018,27(11):1549-1554.
[15] Liu DS,Wang SL,Li JM,et al.Allicin improves carotid artery intima-media thickness in coronary artery disease patients with hyperhomocysteinemia[J].Exp Ther Med,2017,14(2):1722-1726.