Coagulation Function in Patients with Obstructive Sleep Apnea Hypopnea
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摘要:
目的 检测不同严重程度的OSA 患者凝血功能水平，探讨不同严重程度OSA 与凝血功能及睡眠呼吸监测指标的相关性。 方法 选取于2018年1月至2020年1月就诊于昆明医科大学第二附属医院呼吸科行睡眠呼吸监测的患者184例，依据窒息加低通气指数（apnea hypopnea index，AHI）分组，其中正常对照组50例（A组），轻度OSA 45例（B组），中重度OSA 86例（C组）。对所有研究对象检测凝血功能指标。比较正常对照组、轻度OSA组、中重度OSA组凝血功能指标、睡眠呼吸监测指标的差异，同时对凝血功能指标与AHI、夜间最低脉搏血氧饱和度（LSaO2）、最长呼吸暂停时间（LAT）进行相关性分析。 结果 A组、B组、C组APTT、INR、PTR、FIB、TT、D-二聚体、AT、FDPs相比较，差异无统计学意义（P > 0.05）；A组、B组PT相比较，差异无统计学意义（ P > 0.05），A组、B组与C组PT值相比较,C组PT值比A组、B组大，差异有统计学意义（ P < 0.05）；A组、B组C组AHI、LAT值相比，C组比B组、A组大，B组比A组大，差异有统计学意义（ P < 0.05）；A组、B组与C组LSaO 2相比，差异有统计学意义（P < 0.05）；A组与B组LSaO 2相比，差异无统计学意义（P > 0.05），OSA组患者的FDPs与LSaO 2负相关（r = -0.157，P < 0.05）。 结论 中重度OSA引起PT延长，OSA患者FDPs与LSaO2负相关，从而影响凝血功能。 Abstract:Objective To investigate the correlation between OSA with different severity and coagulation function and sleep respiratory monitoring index by detecting the level of coagulation function in OSA patients with different severity. Methods A total of 184 patients undergoing sleep breathing monitoring in the Department of Respiratory Medicine of the Second Affiliated Hospital of Kunming Medical University from January 2018 to January 2020 were selected. According to apnea Hypopnea index（AHI）, patients were divided into 3 groups, including 50 patients in the normal control group（group A）, 45 patients in the mild OSA group（group B）, and 86 patients in the moderate-severe OSA group（group C） . The differences of coagulation function indexes and sleep respiratory monitoring indexes in the normal control group, the mild OSA group and the moderate and severe OSA group were compared, and the correlation between coagulation function indexes and AHI, LSaO2 and LAT were analyzed. Results There were no statistically significant differences in APTT, INR, PTR, FIB, TT, d-dimer, AT and FDPs between group A, B and C（P > 0.05）, no statistically significant differences in PT between group A and B（ P > 0.05）; The PT value of group C was significantly higher than that of group A and B（ P < 0.05）. Compared with group A and Group B, the AHI and LAT values of group C were significantly higher than those of group B and Group A, while those of group B were higher than those of group A. LSaO2 in group A and B was significantly different from that in group C; and FDPs of OSA group was negatively correlated with LSaO2（r = -0.157, P < 0.05）. There was no significant difference in LSaO2 between group A and group B（ P > 0.05）; In OSA group, FDPs was negatively correlated with LSaO2（R = -0.157, P < 0.05）. Conclusion PT prolonged among moderate-severe OSA patients, and FDPs is negatively correlated with LSaO2 in OSA patients, thus affecting coagulation function. -
Key words:
- Obstructive sleep apnea /
- Coagulation /
- PT
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表 1 各组患者的基本情况比较[n（%），（
$\bar x\pm s $ ）]Table 1. Comparison of demographics of patients in each group[n（%），（
$\bar x \pm s $ ）]项目 正常对照组 轻度OSA 中重度 Z/χ2 P 男/女（n） 29/21 37/8 66/22 7.57 0.02 年龄/岁 53（44.00,67.25） 55（48.00,67.50） 57（46.25,69.50） 1.756 0.42 BMI/（kg/m2） 25.94 ± 4.28 26.54 ± 3.59 26.19 ± 4.54 0.42 0.81 
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表 2 各组睡眠监测指标结果（
$\bar x \pm s $ ）Table 2. Results of sleep monitoring in each group（
$\bar x \pm s $ ）项目 正常对照组 轻度OSA 中重度OSA Z/χ2 P AHI（次/h） 1.99 ± 1.62 9.07 ± 3.12* 36.41 ± 23.55*∆ 155.36 < 0.001 最低SaO2（%） 75.32 ± 12.00 75.22 ± 9.67* 68.55 ± 9.89*∆ 21.00 < 0.001 最长呼吸暂停时间（s） 14,75（0.00，30.45） 26.40（20.10，53.75）* 51.85（23.55，85.33）*∆ 34.55 < 0.001 与正常对照组比较，*P< 0.05；与轻度OSA组比较，∆P< 0.05。
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表 3 各组的凝血功能指标
Table 3. Indicators of coagulation function in each group
组别 正常对照组 轻度OSA 中重度OSA Z P PT（s） 12.95（12.08,13.63）* 12.90（12.15,13.75）* 12.95（12.03,13.60） 0.13 0.94 PTR（s） 1.00（0.96,1.07） 1.00（0.98,1.06） 1.01（0,98,1.05） 0.13 0.94 INR（s） 1.00（0.95,1.07） 1.00（0,97,1.08） 1.01（0.97,1.06） 0.15 0.93 APTT（s） 36.70（30.43,39.43） 35.50（30.80,37.56） 35.10（28.58,39.35） 2.78 0.25 FIB（μg/mL） 3.51（2.57,4.66） 3.95（3.09,4.57） 3.42（2.82,4.66） 2.03 0.36 TT（s） 16.05（15.40,16.80） 15.90（15.50,16.70） 16.10（15.53,16.80） 0.69 0.71 D-二聚体（μg/mL） 0.46（0.31,0.90） 0.48（0.30,0.67） 0.48（0.27,0.95） 0.22 0.90 AT（%） 95.00（83.73,101.50） 89.00（79.00,97.00） 87.30（79.38,97.75） 4.54 0.10 FDPs（μg/mL） 2.02（1.22,3.35） 2.23（1.34,3.01） 2.50（1.64,3.31） 1.84 0.40 与中重度OSA比较，比*P< 0.05。
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表 4 睡眠监测指标与凝血功能的相关性分析
Table 4. Correlation analysis between sleep monitoring indexes and coagulation function
指标 AHI LSaO2 LAT rs P rs P rs P PT −0.088 0.238 0.061 0.412 −0.050 0.503 PTR 0.013 0.858 −0.005 0.952 0.017 0.822 INR 0.010 0.894 −0.063 0.396 0.010 0.895 APTT −0.076 0.306 0.020 0.789 −0.145 0.050 FIB 0.029 0.692 −0.057 0.447 −0.044 0.553 TT 0.037 0.287 −0.079 0.287 −0.018 0.805 D-二聚体 0.059 0.424 −0.113 0.129 −0.041 0.582 AT −0.111 0.134 0.099 0.181 −0.083 0.262 FDPs 0.128 0.084 −0.157 0.034* 0.028 0.706 与LSaO2负相关，*P < 0.05。
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