摘要
目的观察阻塞性睡眠呼吸暂停低通气综合征（OSAS）患者的眼动脉、睫状后动脉及视网膜中央动脉的血流参数变化及其对血流的影响。方法病例对照研究。选取2010年10至12月，由体检中心确定的健康超体重者15例作为正常对照组；选取2010年6至12月由睡眠监测中心诊断的42例0sAs患者，分为轻度OSAS组14例，中重度OSAS组28例；进行病例对照研究。所有受试者均行整夜多导睡眠监测；监测次日上午行潮气末二氧化碳、眼压及眼部超声多普勒检查。受试者眼部血管内径和血流速度用中位数（最大值，最小值）表示，采用Kmskal—wallis法检验，组间两两比较采用Bonferroni检验法（仅提供P值）；患者眼血流速度与多导睡眠监测指标的相关性采用偏相关分析法。结果中重度OSAS患者组：眼动脉内径为0．08（0．15，0．06）cm，显著低于对照组0．15（0．26，0．11）cm，差异有统计学意义（P=0．000）；睫状后动脉内径和视网膜中央动脉收缩期血流速度分别为0．10（0．13，0．07）cm和16．50（19．40，13．10）cm/s，显著高于对照组0．05（0．09，0．04）cm和11．30（16．70，8．20）cm／s，差异有统计学意义（PcV内径：P=0．000，视网膜中央动脉收缩期血流速度：P=0．001）。视网膜中央动脉舒张末期血流速度：轻度0sAs患者组为7．00（8．30，4．50）cm/s，中重度0sAS患者组为8．90（9．90，5．10）cm/s，对照组为5．50（7．40，3．40）cm/s；组间舒张末期血流速度差异有统计学意义（χ^2=14．45，P〈0．05）。中重度组睫状后动脉收缩期和舒张末期血流速度分别为32．50（43．10，19．10）cm/s和12．80（15．20，5．70）cm/s，显著高于对照组22．60（32．20，12．40）cm/s和7．20（11．20，3．90）cm/s，也高于轻度组24．00（30．70，13．30）cm/s和8．00（9．90，3．90）cm/s，差异均有统计学意义（睫状后动脉收缩期血流速度：P=0．000，0．002；睫状后动脉舒张末期血流速度：P=0．000，0．001）。眼动脉、睫状后动脉血管内径均与潮气末CO2相关（r=-0．41，-0．34；P〈0．05）；视网膜中央动脉收缩期血流速度与最低血氧饱和度相关（r=-0．37，P〈0．05）；视网膜中央动脉舒张末期血流速度与潮气末二氧化碳、平均血氧饱和度相关（r=0．57，-0．39；P〈0．05），睫状后动脉收缩期血流速度与最低血氧饱和度、微觉醒指数相关（r=-0．34，0．56；P〈0．05）；睫状后动脉舒张末期血流速度与最低血氧饱和度和微觉醒指数相关（r=-0．29，0．61；P〈0．05）。结论OsAs患者的眼动脉、睫状后动脉、视网膜中央动脉的管腔内径和血液流速均发生改变，其眼部血管自主调节功能较正常对照者减弱。
Objective To observe the ophthalmic artery （OA） , central retinal artery （CRA） and posterior ciliary artery （PCA） blood flow and the changes of eye vascular auto-regulation in patients with obstructive sleep apnea-hypopnea syndrome （OSAS）. Methods It was a case-control study. Fifteen health overweight male adult （as normal control ） and 42 patients with OSAS were randomly selected from examination center and sleep detection center, respectively. The OSAS patients were divided into mild （14 patients） and moderate and severe （28 patients） groups based on the apnea-hypopnea index （AHI）. All subjects filled the sleep questionnaire and carried out polysomnogram monitoring all night for at least7 hours. Fasting peripheral venous blood was collected at 7 AM on next day. The end-tidal CO2 （ ETCO2）, intraocular pressure and color doppler sonography were examined next day to record the data in the inspection process before and after Mueller maneuver. Doppler ultrasound measurement of ocular blood flow diameter and blood flow velocity values were described in the median （max, min） and compared with Kruskal-Wallis test. And then two groups were compared with Bonferroni t test. Ocular blood flow velocity of patients with OSAS and PSG monitoring indicators were analyzed using partial correlation analysis. Results OA inner diameter in moderate and severe OSAS group [0. 08 （0. 15,0. 06） cm] was lower than that in healthy control [0. 15 （0. 26,0. 11 ） cm] and the difference was statistically significant（P = 0. 000）. PCA inner diameter in moderate and severe OSAS group [0. 10 （0. 13,0. 07） cm] were higher than that in healthy controls [0. 05 （0. 09,0. 04） cm]. CRA peak systolic velocity （PSV） in moderate and severe OSAS group [ 16. 50 （19.40,13.10） cm/s] was greater than that in healthy controls [ 11.30 （ 16.70,8. 20） cm/s]. The differences between these two groups were statistically significant （ PCA inner diameter： P = 0. 000, CRA-PSV： P =0. 001）. The difference of CRA end diastolic velocity （EDV） between the moderate and severe group [ 8. 90 （9. 90,5. 10） cm/s ], mild group [ 7.00 （ 8.30,4. 50） cm/s ] and healthy control group [5.50 （7.40, 3.40） cm/s] was statistically significant （ χ^2 = 14.45, P 〈0.05）. PCA-PSV [32.50 （43.10, 19. 10） cm/s] and PCA-EDV [ 12. 80 （15.20, 5.70） cm/s] in the moderate and severe group were higher than those in healthy control group [22.60 （32.20,12.40） cm/s] and [7.20 （11.20, 3.90） cm/s] ,as well as those in the mild group [24. 00 （30. 70, 13.30） cm/s] and [8.00 （9.90,3.90） cm/s]. These differences were statistically significant （PCA-PSV： P = 0. 000,0. 002; PCA-EDV： P = 0. 000,0. 001 ）. The diameter of OA and PCA correlated negatively with ETCO2 （ r = - 0.41, - O. 34 ; P 〈 O. 05） ; CRA-PSV was correlated with SaO2min （ r = - 0. 37, P 〈 O. 05 ）. CRA-EDV was correlated with ETCO2 and SaO2mean （r = 0. 57, -0. 39;P 〈 0. 05）. PCA-PSV was correlated with SaO2min and MAI （r= -0.34, 0.56; P 〈0.05）. PCA-EDV was correlated SaO2min and MAI （r = -0.29, 0.61; P 〈 0.05）. Conclusions The diameter and blood flow of OA, PCA and CRA change in OSAS patients. Compared with non-OSAS patients, the autoregulation function of PCA and CRA is weakened in OSAS patients.
出处
《中华眼科杂志》
CAS
CSCD
北大核心
2012年第7期631-636,共6页
Chinese Journal of Ophthalmology
