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目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血流动力学及血栓前状态分子标志物的变化及其意义。方法测定36例OSAHS患者和30例健康对照组的全血高、低切粘度及血浆粘度、凝血酶原片段1+2(F1+2)、血浆抗凝血酶Ⅲ、P选择素及D二聚体,并比较其差异。结果OSAHS组与健康对照组比较,除血浆抗凝血酶Ⅲ活性降低(P<0.05)外,余均升高(P<0.05)。相关分析发现全血高切粘度、F1+2、P选择素、D二聚体及血浆抗凝血酶Ⅲ活性与呼吸紊乱指数、最低血氧饱和度、最长呼吸暂停时间及血氧饱和度<90%时间占总睡眠时间百分比(SIT90)均相关(P<0.05),全血低切粘度及血浆粘度与呼吸紊乱指数及SIT90相关(P<0.05)。结论OSAHS患者存在血流动力学异常及凝血、抗凝、纤溶状态及血小板活性变化,可能是OSAHS患者易于合并心脑血管栓塞性疾病的重要原因。
Objective To investigate the changes of hemodynamics and molecular markers of prethrombotic state in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and its significance. Methods Thirty-six patients with OSAHS and 30 healthy controls were enrolled in this study. Their blood viscosity, plasma viscosity, prothrombin fragment 1 + 2 (F1 + 2), plasma antithrombin Ⅲ, P-selectin and D 2 Aggregates, and compare their differences. Results Compared with the healthy control group, the OSAHS group was higher than that of the plasma antithrombin Ⅲ activity (P <0.05). Correlation analysis showed that the indexes of whole blood hyperviscosity, F1 + 2, P-selectin, D-dimer and plasma antithrombin Ⅲ activity and respiratory disturbance index, the lowest oxygen saturation, the longest apnea time and the oxygen saturation <90% of the time was related to the percentage of total sleep time (SIT90) (P <0.05). Low shear viscosity and plasma viscosity of whole blood were correlated with respiratory disturbance index and SIT90 (P <0.05). Conclusion There are hemodynamic abnormalities and changes of blood coagulation, anticoagulation, fibrinolysis and platelet activity in patients with OSAHS, which may be an important reason for OSAHS patients’ easy combination of cardiovascular and cerebrovascular embolism.