海马区磁共振波谱成像在持续气道正压通气治疗睡眠呼吸暂停低通气综合征效果评估中的作用

摘要

目的 探讨海马区磁共振波谱成像(MRS)在持续气道正压通气(CPAP)治疗睡眠呼吸暂停低通气综合征(SAHS)效果评估中的作用.方法 将43例中重度SAHS患者分为对照组(19例)和治疗组(24例).治疗组予以CPAP治疗,对照组予以一般治疗.所有患者在治疗前和治疗1年后均行脉搏血氧监测和脑部海马区MRS检查并进行比较.结果 除治疗组夜间最低脉搏血氧饱和度(LSpO2)低于对照组(P＜0.05)外,两组患者的性别构成比、年龄、BMI等一般资料、睡眠呼吸监测指标及治疗前的其他脉搏血氧监测和MRS结果比较,差异均无统计学意义(P＞0.05).与治疗前比较,对照组治疗后N-乙酰门冬氨酸(NAA)、肌酸(Cr)和NAA/Cr降低,胆碱(Cho)、Cho/Cr和乳酸(Lac)/Cr升高(P＜0.05);治疗组治疗后夜间平均脉搏血氧饱和度(MSpO2)、LSpO2和NAA/Cr升高,夜间脉搏血氧饱和度低于90％的时间占总睡眠时间的百分比(SIT90)、夜间脉搏血氧饱和度下降至少4％的次数占总睡眠时间的百分比(即氧减饱和指数,ODI4)、Lac和Lac/Cr降低(P＜0.05).治疗后,治疗组LSpO2、NAA和NAA/Cr高于对照组,ODI4、Cho、Lac、Cho/Cr和Lac/Cr低于对照组(P＜0.05).结论 CPAP治疗可部分改善SAHS患者脑部代谢受损,海马区MRS中的Lac/Cr对缺氧改善高度敏感,可以作为评估CPAP疗效的指标之一.%Objective To explore the effect of magnetic resonance spectroscopy (MRS) of hippocampus in the evaluation of continuous positive airway pressure (CPAP) in sleep apnea hypopnea syndrome(SAHS).Methods Forty three moderate and severe SAHS patients were divided into control group(19 cases) and treatment group (24 cases).CPAP were carried out in the treatment group and ordinary therapy in the control group.Pulse oxygen monitoring and hippocampal MRS were performed in all patients before treatment and one year later,and to compare the results.Results Except that the lowest pulse oxygen saturation (LSpO2) of the treatment group was lower than the control group (P ＜ 0.05) before treatment,there were no significant differences of general information such as sex ratio,age,bodymass index,indexes of polysomnography,other indexes of pulse oxygen monitoring and MRS between the two groups (P ＞ 0.05).Compared with before treatment,N-acetylaspartate (NAA),creative (Cr) andNAA/Cr of the control group after treatment decreased,and choline (Cho),Cho/Cr,lactate (Lac)/Cr increased(P ＜0.05).The mean pulse oxygen saturation,LSpO2 and NAA/Cr of the treatment group after treatment increased,but the percentage of time spent at SaO2 below 90％ (SIT90),the percentage of number spent at oxygen desaturatio≥4％ (oxygen desaturation index,ODI4),Lac and Lac/Cr decreased (P ＜ 0.05).After treatment,LSpO2,NAA and NAA/Cr of the treatment group were higher than those in the control group,but ODI4,Cho,Lac,Cho/Cr and Lac/Cr of the treatment group were lower than those in the control group (P ＜ 0.05).Conclusion CPAP can partly improve the brain metabolic damage of SAHS patients.Lac/Cr in MRS is highly sensitive to improvement of anoxia,which can act as a commendable index to evaluate the effect of CPAP on brain damage.