Page 64 - 2023-02-中国全科医学

2023年1月 第26卷 第2期 http: //www.chinagp.net E-mail: zgqkyx@chinagp.net.cn ·185·

【Abstract】 Background Obstructive sleep apnea-hypopnea syndrome（OSAHS） can cause secondary
polycythemia and elevated hemoglobin，but the prevalence and predictive value of elevated hemoglobin in OSAHS patients
remain unclear. Objective To explore the prevalence and associated factors of elevated hemoglobin（HGB） and its potential
role in predicating pulmonary hypertension and type Ⅱ respiratory failure in OSAHS patients. Methods We conducted a retrospective
analysis of 1 035 patients with OSAHS diagnosed by polysomnography who were hospitalized at Sleep Medical Center，First
People's Hospital of Yunnan Province from 2018 to 2020. Data of polysomnography，clinical parameters，and comorbidity were
compared between 145 cases with polycythemia and 145 cases with normal HGB. The propensity score matching（PSM） was
used to balance the baseline variables of the age，sex and BMI. Spearman correlation and multiple regression analysis were used
to explore the associated factors of HGB level. The receiver operating characteristic（ROC） curve analysis was used to evaluate
the predictive value of elevated HGB for pulmonary hypertension and type Ⅱ respiratory failure in OSAHS. Results The overall
prevalence of polycythemia was 16.8%（174/1 035） in OSAHS patients. Males（25.7%，157/610） had higher prevalence
of polycythemia than females（4.0%，17/425）（P<0.05）. Patients with a high apnea-hypopnea index（AHI） had higher
mean HGB level and prevalence of polycythemia than those with a mild or moderate AHI（P<0.05）. In comparison to patients
with normal HGB，those with elevated HGB had higher AHI，longer maximum apnea time（maxAT） and sleep time spent at
SpO 2 <90%（TS90%），higher values in laboratory and clinical parameters including red blood cell count，HGB，hematocrit，
mean corpuscular hemcglobin concentration，aspartate aminotransferase，alanine aminotransferase，uric acid（UA），total
cholesterol，triglyceride，T 4 ，T 3 ，partial pressure of carbon dioxide（PaCO 2 ），tetraiodothyronine and triiodothyronine，but
mean oxygen saturation（MSpO 2 ），the lowest oxygen saturation（LSpO 2 ） and partial pressure of oxygen（PaO 2 ）（P<0.05）.
Higher prevalence of hyperuricemia，proteinuria，and hypercapnia and lower prevalence of hypothyroidism were also seen in
those with elevated HGB（P<0.05）. Spearman correlation showed that in patients with elevated HGB，HGB level increased
with the increase of BMI，AHI，maxAT，TS90%，PaCO 2 and UA，but decreased with the increase of MSpO 2 ，LSpO 2 and
PaO 2 （P<0.05）. Age，BMI，maxAT，MSpO 2 ，LSpO 2 ，PaCO 2 ，creatinine and UA were the factors affecting the level of
HGB in multiple regression analysis. ROC curve analysis showed that in male patients，the AUC of HBG in predicting the risk of
pulmonary hypertension was 0.699〔95%CI（0.504，0.893），P=0.033〕with a cutoff value of 169.5 g/L，and its AUC was
0.836〔95%CI（0.682，0.989），P=0.005〕in predicting the risk of type Ⅱ respiratory failure with a cutoff value of 181.5 g/L.
Conclusion The prevalence of elevated HGB was high in patients with OSAHS in Kunming，which may be associated with the
severity of hypoxemia and lung ventilation during sleep. Patients with elevated HGB had severer conditions and higher prevalence
of comorbidities. Elevated HGB may be a predictor of higher risk of pulmonary hypertension and type Ⅱ respiratory failure in male
patients.
【Key words】 Sleep apnea，obstructive；Polycythemia；Hemoglobins；Pulmonary arterial hypertension；Respiratory
insufficiency；Forecasting

阻塞性睡眠呼吸暂停低通气综合征（OSAHS）是常 预测并发症的发生 ［10］ ，但 HGB 是否与 OSAHS 严重程
见的睡眠呼吸障碍性疾病，以睡眠中反复呼吸中断引起 度相关仍存在分歧，对不同临床合并症发生风险的预测
间歇性低氧、二氧化碳（CO 2 ）升高、睡眠片段化等病 临界值也尚不清楚。OSAHS 是否引起 HGB 增多及其影
理改变为特征，临床上主要表现为多睡、失眠及躯体疾 响因素尚无公认的结论，HGB 增多对 OSAHS 患者的临
［1］
病（如高血压、糖尿病及其他心脑血管疾病）等症候群 。 床意义、是否可以作为 OSAHS 病情严重程度的预测指
近年来随着社会经济发展水平的提高，OSAHS 的患病 标等也尚不清楚。本研究通过横断面调查和回顾性分析
率逐年升高 ［2］ 。研究证实，OSAHS 是高血压、冠心病、 住院患者的临床资料，旨在评估未经治疗的 OSAHS 患
卒中、糖尿病、高脂血症、高尿酸血症等常见慢性疾病 者 HGB 增多发生率及影响因素，探讨 HGB 增多的临床
的独立危险因素，并与泌尿系统、消化系统、血液系统、 意义和预测 OSAHS 病情严重程度的价值。
神经系统等多个系统的损害相关 ［3］ 。 1 对象与方法
在 OSAHS 靶器官损害的众多研究中，有研究报道 1.1 研究对象 选取 2018—2020 年在云南省第一人民
OSAHS 患者的血红蛋白（HGB）增多发生率远高于正 医院睡眠医学中心住院的 1 035 例 OSAHS 患者为研究
常人群 ［4］ ，OSAHS 患者的间歇低氧与 HGB 增多存在 对象，患者均经过多导睡眠监测（PSG）检查确诊。本
显著相关性 ［5-7］ 。但有研究则指出 OSAHS 患者的呼吸 研究基于自愿和知情同意的原则，并经云南省第一人民
暂停和间歇性低氧不会导致 HGB 增多 ［8-9］ 。此外，有 医院伦理委员会审批（2017YY105）。
研究者提出，HGB 可以用于评估 OSAHS 的严重程度和 1.1.1 纳入标准 （1）年龄 18~75 岁；（2）符合《阻