伴有阻塞性睡眠呼吸暂停低通气综合征的脑梗死患者血同型半胱氨酸的变化

目的 探讨脑梗死伴随阻塞性睡眠呼吸暂停低通气综合征(OSA)患者的血同型半胱氨酸(Hcy)的水平变化.方法 从南京卒中注册系统中筛选2009年3-12月男性急性脑梗死患者,共92例,根据呼吸暂停加低通气指数(AHI)值将病例为无OSA组(AHI＜5/h)与伴OSA组(AHI≥5/h)两组,在脑梗死发病后第(14±2)天检查多导睡眠图与血Hey等生化指标.结果 脑梗死伴OSA组患者的血Hcy水平为(17±5)μmol/L,显著高于无OSA组(11±3)μmol/L(P＜0 01).根据AHI值,将所有病例分为无OSA组(AHI 5～14/h)、轻度OSA组(AHI 5～14/h)、中度OSA组(AHI 15～30/h)和重度OSA(AHI＞30/h),四组的血Hcy分别为(11±3)μmol/L、(14±3)μmol/L、(17±5)μmol/L和(21±5)μmol/L,差异有统计学意义(P＜0.01),进一步组问两两比较,无OSA组均显著低于其他三组(P＜0 05).将血Hcy与AHI作Pearson相关分析,显示Hcy与AHI呈现正相关(r=0 482,P＜0 01).多元线性回归模型校正其他因素后,仍显示AHI(β=0 671,P=0.001)是血Hcy 水平的独立预测因子(R2=0.539,P＜0.01).结论 在脑梗死患者合并OSA时Hcy具有升高趋势,且随着阻塞程度的进展而加重.

Abstract：

Objective To investigate the association of plasma homocysteine and OSA (obstructive sleep apnea) syndrome in ischemic stroke (IS) . Methods A total of 92 male IS patients were classified by apnea hypopnea index (AHI) into 2 groups: non-OSA group (AHI＜5/h) and OSA group (AHI≥5). All patients were tested for plasma homocysteine when polysomnography was finished at (14±2) d after the onset of IS. Results The mean level of homocysteine was significantly higher in the OSA group than that in the non-OSA group (17±5 vs 11±3μmol/L, P＜0.01). Pearson correlation analysis revealed a positive correlation between the homocysteine level and the severity of AHI (r=0.482, P＜0.01). Further multiple linear regression analysis showed that AHI and folate were independent predictors of homocysteine level (R2=0.553, P＜0.01, β for AHI=0.671, β for folate=-0.256). Conclusion The severity of OSA is significantly associated with an elevated level of homocysteine in IS patients. And this association is independent of other causative factors of an elevated level of homocysteine.

Plasma homocyeteine levels in ischemic stroke patients with obstructive sleep apnea

Objective To investigate the association of plasma homocysteine and OSA (obstructive sleep apnea) syndrome in ischemic stroke (IS) . Methods A total of 92 male IS patients were classified by apnea hypopnea index (AHI) into 2 groups: non-OSA group (AHI＜5/h) and OSA group (AHI≥5). All patients were tested for plasma homocysteine when polysomnography was finished at (14±2) d after the onset of IS. Results The mean level of homocysteine was significantly higher in the OSA group than that in the non-OSA group (17±5 vs 11±3μmol/L, P＜0.01). Pearson correlation analysis revealed a positive correlation between the homocysteine level and the severity of AHI (r=0.482, P＜0.01). Further multiple linear regression analysis showed that AHI and folate were independent predictors of homocysteine level (R2=0.553, P＜0.01, β for AHI=0.671, β for folate=-0.256). Conclusion The severity of OSA is significantly associated with an elevated level of homocysteine in IS patients. And this association is independent of other causative factors of an elevated level of homocysteine.