中国全科医学 ›› 2023, Vol. 26 ›› Issue (02): 184-191.DOI: 10.12114/j.issn.1007-9572.2022.0216

所属专题: 睡眠问题专题研究

• 论著 • 上一篇    下一篇

阻塞性睡眠呼吸暂停低通气综合征患者血红蛋白增多发生率及其临床意义研究

赵彬吉1, 郭竞宇1, 周佳瑾1, 牟兰雪1, 母桃娟2, 张开艳2, 吕云辉1,*()   

  1. 1650500 云南省昆明市,昆明理工大学医学院 云南省第一人民医院睡眠医学中心
    2650300 云南省昆明市,云南新昆华医院睡眠医学中心
  • 收稿日期:2022-02-23 修回日期:2022-05-06 出版日期:2023-01-15 发布日期:2022-11-02
  • 通讯作者: 吕云辉
  • 赵彬吉,郭竞宇,周佳瑾,等.阻塞性睡眠呼吸暂停低通气综合征患者血红蛋白增多发生率及其临床意义研究[J].中国全科医学,2023,26(2):184-191.[www.chinagp.net]
    作者贡献:赵彬吉进行文章的研究设计与实施,文章的可行性分析,文献收集、整理,撰写论文;郭竞宇、周佳瑾、牟兰雪、母桃娟、张开艳进行研究实施,资料收集、数据管理;吕云辉负责监督管理、质量控制及审校,对文章整体负责。
  • 基金资助:
    国家自然科学基金地区基金项目(81760022); 云南省科技厅-昆明医科大学应用基础研究联合专项基金项目(2018FE001(-107),2018FE001(-295)); 昆明市卫生科技人才培养暨技术中心建设项目(SW(技)-32)

Prevalence and Predictive Value of Elevated Hemoglobin in OSAHS Patients

ZHAO Binji1, GUO Jingyu1, ZHOU Jiajin1, MOU Lanxue1, MU Taojuan2, ZHANG Kaiyan2, LYU Yunhui1,*()   

  1. 1School of Medicine, Kunming University of Science and Technology/Sleep Medical Center, First People's Hospital of Yunnan Province, Kunming 650500, China
    2Sleep Medical Center, Yunnan Province New Kun Hua Hospital, Kunming 650300, China
  • Received:2022-02-23 Revised:2022-05-06 Published:2023-01-15 Online:2022-11-02
  • Contact: LYU Yunhui
  • About author:
    ZHAO B J, GUO J Y, ZHOU J J, et al. Prevalence and predictive value of elevated hemoglobin in OSAHS patients [J] . Chinese General Practice, 2023, 26 (2) : 184-191.

摘要: 背景 阻塞性睡眠呼吸暂停低通气综合征(OSAHS)可引起红细胞和血红蛋白(HGB)增多,但对于OSAHS患者HGB增多发生率及其对临床合并症的预测价值尚无公认的结论。 目的 探讨OSAHS患者HGB增多发生率、相关影响因素以及其对肺动脉高压和Ⅱ型呼吸衰竭的预测作用。 方法 选取2018—2020年在云南省第一人民医院睡眠医学中心住院的1 035例OSAHS患者为研究对象;采用倾向性评分匹配均衡基线资料,HGB增多者纳入HGB增多组(n=145),与之年龄、性别、体质指数(BMI)匹配的HGB未增高者纳入HGB正常组(n=145);比较两组间多导睡眠监测(PSG)参数、临床检测指标和合并症发生率的差异。采用Spearman秩相关分析、多重线性回归分析探究HGB的影响因素;采用受试者工作特征(ROC)曲线评估HGB预测OSAHS发生肺动脉高压和Ⅱ型呼吸衰竭的价值。 结果 OSAHS患者HGB增多发生率为16.8%(174/1 035),其中男性患者HGB增多发生率25.7%(157/610)高于女性患者4.0%(17/425)(P<0.05),呼吸暂停低通气指数(AHI)重度的OSAHS患者HGB和HGB增多发生率均高于中度和轻度患者(P<0.05)。HGB增多组的OSAHS患者AHI、最长呼吸暂停持续时间(maxAT)、血氧饱和度小于90%的时间占总监测时间的百分比(TS90%)、红细胞计数(RBC)、HGB、血细胞比容(HCT)、平均HGB浓度(MCHC)、天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、血清尿酸(UA)、总胆固醇(TC)、三酰甘油(TG)、甲状腺素(T4)、三碘甲状腺原氨酸(T3)、动脉血二氧化碳分压(PaCO2)水平高于HGB正常组,平均血氧饱和度(MSpO2)、最低血氧饱和度(LSpO2)、动脉血氧分压(PaO2)均低于HGB正常组(P<0.05);HGB增多组合并高尿酸血症、蛋白尿、高碳酸血症的发生率高于HGB正常组,合并甲状腺功能减退的发生率低于HGB正常组(P<0.05)。HGB增多患者HGB水平与BMI、AHI、maxAT、TS90%、PaCO2、UA呈正相关(P<0.05),与MSpO2、LSpO2、PaO2呈负相关(P<0.05)。多重线性回归分析结果显示,年龄、BMI、maxAT、MSpO2、LSpO2、PaCO2、血清肌酐(Cr)、UA为HGB的影响因素(P<0.05)。预测男性OSAHS患者肺动脉高压的HGB临界值为169.5 g/L,ROC曲线下面积(AUC)为0.699〔95%CI(0.504,0.893),P=0.033〕;预测男性OSAHS患者Ⅱ型呼吸衰竭的HGB临界值为181.5 g/L,AUC为0.836〔95%CI(0.682,0.989),P=0.005〕。 结论 昆明地区OSAHS患者HGB增多发生率高,HGB增高程度与夜间低氧程度及肺通气能力有关;伴HGB增多的OSAHS患者病情更为严重,合并症发生率更高。HGB增高的程度对男性OSAHS患者出现肺动脉高压和Ⅱ型呼吸衰竭的风险有预测作用。

关键词: 睡眠呼吸暂停,阻塞性, 红细胞增多症, 血红蛋白类, 肺动脉高压, 呼吸功能不全, 预测

Abstract:

Background

Obstructive sleep apnea-hypopnea syndrome (OSAHS) can cause secondary polycythemia and elevated hemoglobin, but the prevalence and predictive value of elevated hemoglobin in OSAHS patients remain unclear.

Objective

To explore the prevalence and associated factors of elevated hemoglobin (HGB) and its potential role in predicating pulmonary hypertension and type Ⅱ respiratory failure in OSAHS patients.

Methods

We conducted a retrospective analysis of 1 035 patients with OSAHS diagnosed by polysomnography who were hospitalized at Sleep Medical Center, First People's Hospital of Yunnan Province from 2018 to 2020. Data of polysomnography, clinical parameters, and comorbidity were compared between 145 cases with polycythemia and 145 cases with normal HGB. The propensity score matching (PSM) was used to balance the baseline variables of the age, sex and BMI. Spearman correlation and multiple regression analysis were used to explore the associated factors of HGB level. The receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value of elevated HGB for pulmonary hypertension and type Ⅱ respiratory failure in OSAHS.

Results

The overall prevalence of polycythemia was 16.8% (174/1 035) in OSAHS patients. Males (25.7%, 157/610) had higher prevalence of polycythemia than females (4.0%, 17/425) (P<0.05) . Patients with a high apnea-hypopnea index (AHI) had higher mean HGB level and prevalence of polycythemia than those with a mild or moderate AHI (P<0.05) . In comparison to patients with normal HGB, those with elevated HGB had higher AHI, longer maximum apnea time (maxAT) and sleep time spent at SpO2<90% (TS90%) , higher values in laboratory and clinical parameters including red blood cell count, HGB, hematocrit, mean corpuscular hemcglobin concentration, aspartate aminotransferase, alanine aminotransferase, uric acid (UA) , total cholesterol, triglyceride, T4, T3, partial pressure of carbon dioxide (PaCO2) , tetraiodothyronine and triiodothyronine, but mean oxygen saturation (MSpO2) , the lowest oxygen saturation (LSpO2) and partial pressure of oxygen (PaO2) (P<0.05) . Higher prevalence of hyperuricemia, proteinuria, and hypercapnia and lower prevalence of hypothyroidism were also seen in those with elevated HGB (P<0.05) . Spearman correlation showed that in patients with elevated HGB, HGB level increased with the increase of BMI, AHI, maxAT, TS90%, PaCO2 and UA, but decreased with the increase of MSpO2, LSpO2 and PaO2 (P<0.05) . Age, BMI, maxAT, MSpO2, LSpO2, PaCO2, creatinine and UA were the factors affecting the level of HGB in multiple regression analysis. ROC curve analysis showed that in male patients, the AUC of HBG in predicting the risk of pulmonary hypertension was 0.699〔95%CI (0.504, 0.893) , P=0.033〕with a cutoff value of 169.5 g/L, and its AUC was 0.836〔95%CI (0.682, 0.989) , P=0.005〕in predicting the risk of type Ⅱrespiratory failure with a cutoff value of 181.5 g/L.

Conclusion

The prevalence of elevated HGB was high in patients with OSAHS in Kunming, which may be associated with the severity of hypoxemia and lung ventilation during sleep. Patients with elevated HGB had severer conditions and higher prevalence of comorbidities. Elevated HGB may be a predictor of higher risk of pulmonary hypertension and type Ⅱrespiratory failure in male patients.

Key words: Sleep apnea, obstructive, Polycythemia, Hemoglobins, Pulmonary arterial hypertension, Respiratory insufficiency, Forecasting