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中华胃食管反流病电子杂志

中华胃食管反流病电子杂志 ›› 2018, Vol. 05 ›› Issue (01) : 1 -6. doi: 10.3877/cma.j.issn.1674-6899.2015.01.001

所属专题： 文献；

论著

OSA患者的呼吸力学特征及血清肺泡表面活性物质水平与其胃食管反流事件的关系研究
阿孜古丽·买合买提1, 艾力根·阿不都热依木2,†(), 米日古丽·吾木哈斯木1, 穆叶斯尔·哈斯木1   
  1. 1. 830002　乌鲁木齐，新疆石油管理局明园职工医院内一科
    2. 830001　乌鲁木齐，新疆维吾尔自治区人民医院耳鼻咽喉诊疗中心
  • 收稿日期:2017-12-25 出版日期:2018-02-15
  • 通信作者: 艾力根·阿不都热依木

The relationship between respiratory mechanical properties of OSA patient and serumsurfactant protein level and with its events of gastroesophageal reflux

Maihemaiti Aziguli1, Abdeyrim Arikin2,†(), Wumuhasimu Miriguli1, Hasimu Muyesier1   

  1. 1. First Department of Medicine, Xinjiang Petroleum Administration MingYuan Works Hospital, Urumuqi 830002, China
    2. Department of Otorhinolaryngology Head and Neck Surgery, The People′s Hospital of Xinjiang Uygur Autonomous Region, Urumuqi 830001, China
  • Received:2017-12-25 Published:2018-02-15
  • Corresponding author: Abdeyrim Arikin
  • About author:
    Corresponding author: Arikin·Abdeyrim, Email:
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阿孜古丽·买合买提, 艾力根·阿不都热依木, 米日古丽·吾木哈斯木, 穆叶斯尔·哈斯木. OSA患者的呼吸力学特征及血清肺泡表面活性物质水平与其胃食管反流事件的关系研究[J]. 中华胃食管反流病电子杂志, 2018, 05(01): 1-6.

Maihemaiti Aziguli, Abdeyrim Arikin, Wumuhasimu Miriguli, Hasimu Muyesier. The relationship between respiratory mechanical properties of OSA patient and serumsurfactant protein level and with its events of gastroesophageal reflux[J]. Chinese Journal of Gastroesophageal Reflux Disease(Electronic Edition), 2018, 05(01): 1-6.

目的

通过评价阻塞性睡眠呼吸暂停(OSA)患者呼吸系统力学特征及其血清肺泡表面活性蛋白水平与其胃食管反流事件3者之间的关系，探寻OSA患者呼吸系统力学特性发生变化的可能原因。

方法

对连续住院的疑似鼾症患者进行多导睡眠监测(PSG)并诊断，同时分别用脉冲振荡肺功能(IOS)测定其呼吸系统力学特征；酶联免疫吸附法测定血清肺泡表面活性物质蛋白(SP-A，-B，-C，-D)及多通道阻抗-pH监测系统，检测并分析比较胃食管及咽喉部24 h的返流状况。

结果

60例经PSG确诊为不同严重程度鼾症的患者，依据其呼吸暂停低通气指数(AHI)将其分为OSAS组与非OSAS进行比较，OSAS组患者的呼吸总阻抗(Zrs5)和全部震荡频率的呼吸阻力(Rrs)显著高于非OSAS组，而呼吸电抗(Xrs)显著降低；OSAS组患者的DeMeester评分及食管近端酸反流、食管反流总值高于非OSAS组，差异具有统计学意义(P<0.01)；OSAS患者的血清肺泡表面活性物质蛋白-B水平低于非OSAS组，差异有统计学意义(P<0.01)。OSAS患者的呼吸总阻抗和呼吸阻力(5～15 Hz)与总反流指数和DeMeester评分正相关(r＝0.614，P＝0.031；r＝0.668，P＝0.015；r＝0.569，P＝0.032；r＝0.563，P＝0.034)；OSAS患者的Xrs5的下降与其血清肺泡表面活性物质蛋白-B水平存在相关性(r＝－0.594，P＝0.023)，而与总反流指数、DeMeester评分负相关(r＝－0.821，P＝0.000；r＝－0.734，P＝0.001)。

结论

随着鼾症患者阻塞性睡眠呼吸程度的加重，其呼吸阻力增加，而呼吸电抗(Xrs5)负值增大；OSAS患者的胃食管及食管近端反流与其呼吸暂停低通气指数正相关；该事件与其呼吸阻力正相关，而与其呼吸电抗显著负相关。

关键词: 阻塞性睡眠呼吸暂停, 胃食管反流, 脉冲震荡, 呼吸力学特征
Objective

To appraise the respiratory mechanical properties, gastroesophageal acid reflux and serum pulmonary surfactant protein levels(SPSPL)in snorer, and the possible cause to change in the mechanical properties of respiratory were aims to discuss through appraised the correlationship between those factors.

Methods

Consecutive snorer were underwent polysomnography to determine whether presence of OSAS or not; Meanwhile, the respiratory mechanical properties was measured by using impulse oscillometry, multichannel intraluminal impedance-pH monitoring was use to record 24 h acid reflux events of gastroesophageal and laryngopharyngeal as well as SPSPL were measured by ELISA methods.

Results

A total of 60 snorer was diagnosed by polysomnography, they were distributed into OSAS and non-OSAS groups according to the snorers AHI; There were significantly increased of the Zrs5 and Rrs at all oscillatory frequencies in OSAS group as well as Xrs was significant lower when compared with non-OSAS group; there are significantly more acid reflux events of gastroesophageal and laryngopharyngeal in OSAS than in non-OSAS group, correspondingly the DeMeeste scores was higher in OSAS group; Significantly lower levels of pulmonary surfactant protein can be found in OSAS patients compared with non-OSAS.

Conclusion

Respiratory resistance at all frequencies and Zrs5 are increaesing with OSA severity increase, and Xrs5 are dropping which may indicate the lungs compliance are decreased; with OSA severity increasing as defined by AHI, there are increased acid reflux episodes of gastroesophageal and proximal esophageal, this associated with respiratory resistance and associated inversely with respiratory reactance.

Key words: Obstructive sleep apnea, Gastroesophageal reflux, Pulse oscillation system, Mechanical properties of respiratory system
表1 60例男性鼾症临床特征和血清肺泡表面活性蛋白和多导睡眠监测结果(±s)
项目 鼾症患者 t值 P值
非-OSAS组(30例) OSAS组(30例)
年龄(岁) 45.53±10.51 47.62±11.71 1.402 0.172
体重指数(kg/m2) 26.54±2.61 33.43±4.20 9.233 0.000
腹围(cm) 101.14±10.48 104.25±11.53 2.031 0.035
超重/肥胖 10/18 4/26 8.225 0.001
吸烟史(未戒烟/戒烟/不吸烟，χ2检验) 13/7/10 5/6/19 2.435 0.390
Brinkman指数 128±179 184±234 1.382 0.131
肺泡表面活性蛋白-A(ng/L) 154.32±38.41 149.23±37.15 1.108 0.224
肺泡表面活性蛋白-B(ng/L) 45.84±6.73 41.13±6.11 6.227 0.007
肺泡表面活性蛋白-C(ng/L) 33.59±6.16 32.97±5.84 0.764 0.597
肺泡表面活性蛋白-D(ng/L) 16.98±3.44 17.28±4.07 0.721 0.501
总睡眠时间(min) 389.41±50.77 386.22±57.14 0.356 0.717
呼吸暂停低通气指数(次/h) 7.12±5.28 34.53±17.87 18.567 0.000
最低氧气饱和度 85.82±4.19 77.50±7.93 11.234 0.000
<3%的减氧指数(ODI3) 16.24±9.24 46.91±21.78 18.432 0.000
<4%的减氧指数(ODI4) 8.20±5.71 35.51±21.54 16.754 0.000
表2 60例鼾症患者呼吸系统力学特性测定及组间的比较(±s)
项目 鼾症患者 t值 P值
非OSAS组(30例) OSAS组(30例)
Zrs5(L/s·kPa-1) 0.35±0.18 0.47±0.17 9.122 0.000
R5(L/s·kPa-1) 0.34±0.19 0.44±0.13 9.457 0.000
R10(L/s·kPa-1) 0.34±0.07 0.38±0.08 9.034 0.000
R15(L/s·kPa-1) 0.31±0.09 0.35±0.06 8.675 0.000
R20(L/s·kPa-1) 0.30±0.08 0.34±0.10 8.582 0.000
R25(L/s·kPa-1) 0.29±0.09 0.33±0.09 7.341 0.000
R35(L/s·kPa-1) 0.33±0.07 0.39±0.07 3.481 0.004
X5(L/s·kPa-1) －0.08[－0.01；－0.16] －0.13[－0.02；－0.21] 2.047 0.048
X10(L/s·kPa-1) －0.03±0.04 －0.07[0.02；－0.13] 3.943 0.003
X15(L/s·kPa-1) 0.01[0.00；－0.09] －0.03[－0.01；－0.11] 3.382 0.005
X20(L/s·kPa-1) 0.04±0.04 0.02[0.00；－0.08] 4.071 0.002
X25(L/s·kPa-1) 0.07±0.02 0.06±0.02 1.987 0.060
X35(L/s·kPa-1) 0.11±0.05 0.11±0.04 0.953 0.646
共振频率(Hz) 15.70±3.72 17.71±6.01 4.532 0.002
表3 60例鼾症MICC联合pH监测参数和DeMeester评分的组间比较
项目 鼾症患者 Z值 P值
非OSAS组(30例) OSAS组(30例)
弱酸反流次数(次/h) 58.97 [48.76；77.45] 52.81 [46.59；68.51] －2.640 0.097
酸反流指数数(次/h) 37.87 [30.38；48.54] 68.11 [64.28；79.34] 8.876 0.000
反流总指数(次/h) 41.43[28.28；47.68] 92.59 [80.21；98.87] 9.228 0.000
DeMeester评分 5.4 [1.9；13.3] 12.7 [7.2；38.7] 5.545 0.001
表4 60例鼾症患者的夜间多导睡眠监测参数与其血清SPs水平的相关性
项目 AHI AI HI 最低氧气饱和度 <3%的减氧指数 <4%的减氧指数
SP-B r＝－0.3111 r＝－0.155 r＝－0.2961 r＝0.1901 r＝－0.161 r＝－0.2131
SP-C r＝－0.092 r＝－0.041 r＝－0.113 r＝0.093 r＝－0.121 r＝－0.114
SP-D r＝－0.2591 r＝－0.082 r＝－0.5121 r＝0.172 r＝－0.081 r＝－0.123
SP-A r＝－0.201 r＝－0.013 r＝－0.081 r＝0.095 r＝－0.077 r＝－0.191
表5 OSA的严重程度与食管近端酸返指数的相关关系
项目 鼾症患者(60例) P值
AHI HI
弱酸反流次数(次/h) 0.632 0.440 0.047
酸反流指数数(次/h) 0.731 0.172 0.000
反流总指数(次/h) 0.757 0.348 0.000
表6 鼾症患者呼吸系统力学特征与血清SP-B水平及与胃食管反流的关系
项目 鼾症患者(60例)
反流总指数 肺泡表面活性蛋B(ng/L) DeMeester评分
Zrs5 r＝0.6141 r＝－0.356 r＝0.7431
R5 r＝0.6681 r＝－0.430 r＝0.6931
R10 r＝0.5691 r＝－0.389 r＝0.7121
R15 r＝0.5631 r＝－0.434 r＝0.7191
X5 r＝－0.8211 r＝－0.5941 r＝－0.7341
X10 r＝0.077 r＝－0.454 r＝－0.223
X15 r＝0.154 r＝－0.573 r＝－0.482
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