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  本文選題：阻塞性睡眠呼吸暫停低通氣綜合征　切入點：甲狀腺激素水平　出處：《福建醫(yī)科大學(xué)》2010年碩士論文　論文類型：學(xué)位論文

【摘要】： 目的 研究甲狀腺激素在阻塞性睡眠呼吸暫停低通氣綜合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)中的變化,并進一步探討甲狀腺激素水平的變化在OSAHS的發(fā)生、發(fā)展及并發(fā)癥中的意義,為尋找防治OSAHS并發(fā)癥的途徑提供思路。 方法 實驗1.連續(xù)入選因打鼾在我院經(jīng)多導(dǎo)睡眠儀行夜間7小時睡眠監(jiān)測患者116例,夜間行多導(dǎo)睡眠呼吸監(jiān)測,清晨抽取靜脈血用放射免疫分析法檢測血漿FT3、FT4、sTSH濃度,采用Olympus2700全自動生化分析儀測定血脂及血糖,依據(jù)多導(dǎo)睡眠監(jiān)測結(jié)果,采用兩種不同的分組方法分組如下:1.依據(jù)患者病情輕重(即AHI水平)分為:20例單純鼾癥組、28例輕度OSAHS組、34例中度OSAHS組、34例重度OSAHS組;2、依據(jù)患者缺氧程度不同(即最低血氧飽和度水平)分為:無明顯缺氧組21例、輕度缺氧組43例、中度缺氧組30例、重度缺氧組22例。對比各實驗組患者間FT3、FT4、sTSH濃度的差異以及不同指標間的相關(guān)性。 實驗2.開展干預(yù)實驗,對OSAHS組并缺氧患者予以經(jīng)鼻持續(xù)氣道正壓通氣(nasal continuous positive air pressure,nCPAP)治療并隨訪3個月,共有90例患者接受nCPAP治療,依據(jù)隨訪時間的先后連續(xù)入選30例經(jīng)nCPAP治療滿3個月者,其中治療之前診斷輕度缺氧患者7例、中度缺氧患者12例、重度缺氧患者11例,比較兩組患者治療前后的主要睡眠參數(shù)、FT3、FT4、sTSH濃度變化。 運用SPSS11.5統(tǒng)計軟件進行分析。計量資料采用單因素方差分析及協(xié)方差分析,計數(shù)資料采用R×C表χ2檢驗,兩因素相關(guān)性研究采用Pearson相關(guān)系數(shù)進行直線回歸分析,并采用多元回歸分析法進行預(yù)測因子的評價,治療前后比較用配對t檢驗。P0.05為差異有統(tǒng)計學(xué)意義。 結(jié)果 1、不同病情組:①不同病情組FT4濃度值差異有統(tǒng)計學(xué)意義,但兩兩比較顯示僅重度OSAHS組明顯低于單純鼾癥組、輕度OSAHS組及中度OSAHS組且差別有顯著意義,單純鼾癥組、輕度OSAHS組及中度OSAHS組之間差別無統(tǒng)計學(xué)意義。②FT3、sTSH濃度值各組間差別無統(tǒng)計學(xué)意義,兩兩比較各組間差別亦無統(tǒng)計學(xué)意義。2、不同缺氧程度組:①伴隨末梢氧濃度降低FT4濃度值逐漸降低且差異有統(tǒng)計學(xué)意義,兩兩比較各組間均有差別且有統(tǒng)計學(xué)意義。②FT3、sTSH濃度值各組間差別無統(tǒng)計學(xué)意義,兩兩比較各組間差別亦無統(tǒng)計學(xué)意義。 3、Pearson相關(guān)系分析顯示:FT4濃度與最低血氧濃度呈正相關(guān)(r= 0.899、P0.01),與氧減指數(shù)、TS90%(血氧小于90%的時間)、嗜睡評分呈負相關(guān)(r=-0.861 ,P0.01;r=-0.821 ,P0.01;r=-0.759 ),與TCHO、TG、VLDL、空腹血糖相關(guān)系數(shù)分別為:(r=-0.183 ,P0.05,r=-0.372 ,P0.05;r=-0.476 ,P0.01; r=-0.145 ,P0.05),FT3、sTSH與以上指標無明顯相關(guān)性。 4.多元回歸分析顯示最低血氧濃度X1、氧減指數(shù)X2、嗜睡評分X3及睡眠呼吸暫停低通氣時間指數(shù)(AHTI) X4為FT4水平的預(yù)測因素,t值分別為6.004(P0.01)、-5.022 (P0.01)、-3.386(P0.05)、-1.988 (P0.05)。多元回歸方程為:FT4=-2.286+0.275X1-0.084X2-0.16X3-0.023X4。 5.30例OSAHS患者經(jīng)nCPAP治療3個月后,患者FT4水平明顯升高且差別有統(tǒng)計學(xué)意義, FT3、sTSH治療前后則無明顯變化。 結(jié)論: 1.重度OSAHS組甲狀腺激素水平明顯高于單純鼾癥組及輕、中度OSAHS組,提示睡眠呼吸暫停低通氣綜合癥發(fā)展到一定程度可能引起甲狀腺激素水平變化。 2.缺氧越嚴重FT4水平越低,提示睡眠呼吸暫停低通氣所致的間斷性缺氧可能是導(dǎo)致睡眠呼吸暫�；颊呒谞钕偌に厮阶兓闹匾蛩�。 3.FT4水平變化與最低血氧飽和度、氧減指數(shù)、TS90%、嗜睡評分成直線相關(guān),提示甲狀腺激素水平的變化不僅與缺氧的程度有關(guān),而且與間斷缺氧的頻率、缺氧的時間密切相關(guān),并且提示甲狀腺激素水平下降可能與睡眠呼吸暫�；颊叩陌滋爝^度嗜睡等臨床表現(xiàn)有關(guān),FT4水平與TCHO、TG、VLDL、空腹血糖等指標密切相關(guān)提示甲狀腺激素水平的變化可能為OSAHS患者的血脂、血糖異常等并發(fā)癥的重要影響因素。 4.經(jīng)nCPAP治療后,患者FT4水平明顯升高,提示nCPAP治療可以糾正OSAHS患者甲狀腺激素水平,從而改善臨床癥狀,預(yù)防或緩解睡眠呼吸暫停綜合征患者并發(fā)癥的發(fā)生、發(fā)展。
[Abstract]:objective
Study of thyroid hormone in obstructive sleep apnea hypopnea syndrome (obstructive sleep apnea-hypopnea syndrome, OSAHS) in the changes, and to further explore the changes of thyroid hormone level in OSAHS occurrence, development and clinical significance, to provide ideas for ways to prevention and treatment of OSAHS complications.
Method
Experiment 1. consecutive snoring by polysomnography for 7 hours a night sleep monitoring of patients with 116 cases in our hospital, night polysomnography, morning venous blood by radioimmunoassay to detect plasma FT3, FT4, sTSH concentration, using Olympus2700 automatic biochemical analyzer for determination of blood lipid and blood sugar, according to the sleep monitoring results, by grouping two different grouping methods are as follows: 1. according to the severity of disease (i.e. AHI) is divided into: 20 patients with simple snoring group, 28 cases of mild OSAHS group, moderate OSAHS group 34 cases, 34 cases of severe OSAHS group; 2 patients, according to different degree of hypoxia (i.e. the lowest oxygen the saturation level) is divided into: no obvious hypoxia group 21 cases, 43 cases of mild hypoxia group, moderate hypoxia group 30 cases, 22 cases of severe hypoxia group. The patients in the experimental group compared to FT3, FT4, and sTSH concentration differences between different indicators of relevance.
Experiment 2. carried out intervention experiment, OSAHS group and hypoxia treated with nasal continuous positive airway pressure (nasal continuous positive air pressure, nCPAP) treatment and follow-up of 3 months, a total of 90 patients received nCPAP treatment, on the basis of follow-up time sequence of 30 consecutive patients treated with nCPAP for 3 months, which the treatment before the diagnosis of 7 cases of patients with mild hypoxia, 12 cases of patients with moderate hypoxia, severe hypoxia in patients with 11 cases, the main sleep parameters, two groups were compared before and after treatment of FT3, FT4, sTSH concentration.
The data was analyzed by using SPSS11.5 software. The measurement data using single factor analysis of variance and covariance analysis, count data using R * C Table 2 test, study the correlation between the two factors using the Pearson correlation coefficient of linear regression analysis, and analysis the evaluation of predictors by multivariate regression, before and after treatment was compared with paired t test for difference.P0.05 there was statistical significance.
Result
1 different disease groups: different disease group FT4 concentration difference was statistically significant, but the 22 shows only severe OSAHS group was significantly lower than that in simple snoring group, significant mild OSAHS group and moderate group OSAHS and the difference between Dan Chunhan's disease group, mild OSAHS group and moderate OSAHS groups had no significant difference. FT3, sTSH concentration between the groups there was no significant difference between the 22 groups were compared, the difference was not statistically significant.2, different degree of hypoxia groups associated with peripheral oxygen concentration and decrease the concentration of FT4 decreased and the difference was statistically significant, the 22 groups were different and the difference was statistically significant. The FT3 value of sTSH concentration between groups there was no significant difference between the 22 groups were compared, the difference was not statistically significant.
3, analysis of Pearson correlation showed that FT4 concentration correlated with the lowest oxygen concentration (r= 0.899, P0.01), and TS90% (oxygen desaturation index, less than 90% of the time), sleepiness score was negatively correlated (r=-0.861, P0.01; r=-0.821, P0.01; r=-0.759), and TCHO, TG, VLDL, fasting glucose the coefficient were: (r=-0.183, P0.05, r=-0.372, P0.05; r=-0.476, P0.01; r=-0.145, P0.05, FT3), there was no correlation between sTSH and the above indexes.
4. multivariate regression analysis showed the lowest oxygen concentration X1, oxygen desaturation index X2, X3 sleepiness score and sleep apnea hypopnea index (AHTI) time X4 predictive factors for FT4 levels, t values were 6.004 (P0.01), -5.022 (P0.01), -3.386 (P0.05), -1.988 (P0.05) multiple regression equation. For: FT4=-2.286+0.275X1-0.084X2-0.16X3-0.023X4.
5.30 cases of OSAHS patients were treated with nCPAP for 3 months, and the level of FT4 was significantly higher and the difference was statistically significant. There was no significant change before and after the treatment of sTSH.
Conclusion:
1., the thyroid hormone level in severe OSAHS group was significantly higher than that in simple snoring group and mild or moderate OSAHS group, suggesting that the development of sleep apnea hypopnea syndrome may lead to a change in thyroid hormone level.
2., the more severe anoxia is, the lower the level of FT4. It suggests that intermittent hypoxia induced by sleep apnea hypopnea may be an important factor leading to the change of thyroid hormone level in patients with sleep apnea.
The change of 3.FT4 level and the lowest oxygen saturation, oxygen desaturation index, TS90% sleepiness score, a linear correlation, suggests that the changes of thyroid hormone level is not only related to the degree of hypoxia, and the frequency of intermittent hypoxia, hypoxia is closely related to the time, and suggest that thyroid hormone level may be decreased in patients with sleep apnea and excessive daytime sleepiness. The clinical manifestations, FT4 level and TCHO, TG, VLDL, fasting blood glucose and other indicators may change that closely related to thyroid hormone levels of blood lipids in patients with OSAHS, important factors of abnormal blood glucose and other complications.
4. after nCPAP treatment, the FT4 level of patients increased significantly, suggesting that nCPAP therapy can correct thyroid hormone levels in OSAHS patients, thereby improving clinical symptoms, preventing or alleviating the occurrence and development of complications in patients with sleep apnea syndrome.

【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號】：R766

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本文編號：1571979