合并及不合并阻塞性睡眠呼吸暂停脑卒中患者的咽部MRI分析

doi:10.13418/j.issn.1001-165x.2018.05.006

中国临床解剖学杂志 ›› 2018, Vol. 36 ›› Issue (5): 507-513.doi: 10.13418/j.issn.1001-165x.2018.05.006

合并及不合并阻塞性睡眠呼吸暂停脑卒中患者的咽部MRI分析

伍琦¹，　张丽霞²，　张虔³，　陆甘⁴，　袁勇⁵，　王彤²

1.南华大学附属第一医院康复医学科，湖南衡阳 421001； 2.南京医科大学第一附属医院康复医学科，江苏南京 210009； 3.库尔勒巴州人民医院康复医学科，新疆维吾尔自治区库尔勒 841000； 4.江苏省省级机关医院呼吸内科，江苏南京 210009； 5.江苏省省级机关医院放射科，江苏南京 210009

收稿日期:2018-04-27 出版日期:2018-09-25 发布日期:2018-10-26
通讯作者: 王彤，教授，博士生导师，Tel：15358166010，E-mail：wangtong60621@163.com
作者简介:伍琦（1987-），主治医师，硕士，研究方向：神经系统康复，吞咽障碍康复，神经性疼痛的治疗， Tel：15200509157，E-mail：wuqi87@126.com
基金资助:
江苏省科技发展计划项目（BE2017752）

Analysis of pharynx MRI in stroke patients with and without obstructive sleep apnea

WU Qi¹, ZHANG Li-xia ², ZHANG Qian³, LU Gan⁴, YUAN Yong⁵, WANG Tong²

1.Department of Rehabilitation, The First Affiliated Hospital of University of South China，Hengyang 421001, Hunan Province, China；2.Department of Rehabilitation, The First Affiliated Hospital of Nanjing Medical University，Nanjing 210009, Jiangsu Province, China； 3.Department of Rehabilitation, Bayinguoleng Mongol Autonomous Prefecture People's Hospital，Korla city 841000, Xinjiang uygur autonomous region, China； 4.Department of Respiratory medicine, Jiangsu provincial authorities Hospital，Nanjing 210009, Jiangsu Province, China； 5.Department of Radiology, Jiangsu provincial authorities Hospital，Nanjing 210009, Jiangsu Province, China

Received:2018-04-27 Online:2018-09-25 Published:2018-10-26

摘要/Abstract

摘要：

目的　通过对脑卒中阻塞性睡眠呼吸暂停（Obstructive Sleep Apnea，OSA）患者与非OSA患者咽部形态进行比较，了解咽部形态与脑卒中OSA的关系。方法　发病30 d内的脑卒中患者入院后夜间行多导睡眠图监测后分为脑卒中OSA组及脑卒中非OSA组，两组患者均行咽部MRI检查并测得腭后距离、舌后距离、软腭长度、舌长、咽侧壁软组织的厚度、高口咽区面积、低口咽区面积、咽部最小面积等相关数值，将两组患者咽部测得相关值进行比较，将腭后距离与其他口咽测量指标、AHI、洼田饮水试验分级、年龄、病程、BMI、颈围行Pearson相关分析，并将腭后距离作脑卒中OSA患者受试者工作特征曲线 (Receiver Operating Characteristic Curve，ROC曲线)分析。结果　脑卒中OSA组患者腭后距离较非OSA患者的偏小（P=0.002），脑卒中OSA患者腭后距离与舌后距离呈相关（R=0.502, P=0.017）；脑卒中OSA患者洼田饮水试验分级较非OSA患者偏高（P=0.049）；脑卒中OSA患者腭后距离与AHI值呈负相关（R=-0.873, P=0.000），腭后距离对脑卒中OSA的ROC曲线下面积为0.888，腭后距离对于脑卒中OSA有中等程度的诊断价值。结论　咽部形态学改变与脑卒中OSA相关，腭后距离对脑卒中OSA有一定的诊断价值，腭后距离与脑卒中OSA严重程度有关；脑卒中OSA患者的洼田饮水分级较非OSA患者高，脑卒中患者OSA可能与吞咽障碍有关。

关键词: 脑卒中, 　睡眠呼吸暂停, 　多导睡眠图, 　口咽部形态学

Abstract:

Objective　 Based on stroke patients with and without Obstructive Sleep Apnea (OSA) with pharyngeal morphological comparison, to understand the relationship of pharyngeal anatomy and OSA in stroke patients.　Methods　Patients within 30 days of stroke underwent nocturnal polysomnography, were divided into two groups based on whether had OSA or not. 3.0 weighted magnetic resonance imaging (MRI) performed for clinical purposes was used to measure retropalatal distance, soft palatal length, soft palatal thickness, retroglossal space, and tongue length, lateral pharyngeal wall thickness，high retropharyngeal area, low retropharyngeal area, minimum retropharyngeal area. The pharyngeal measured data of two groups were compared. Pearson correlation analysis was conducted between the retropalatal distance and other measurement indexes of pharyngeal, AHI, sub-water test score, age, course of disease, BMI and neck circumference in OSA patients with stroke. A receiver operating characteristic curve (ROC) was plotted and the area under it was calculated to assess the ability of retropalatal distance to discriminate OSA status. Results　The retropalatal distance of stoke OSA patients was shorter than that of the compared group（P=0.002）.The retropalatal distance of stoke OSA patients was related with retroglossal space （R=0.502, P=0.017）. The sub-water test score of OSA patients with stroke was higher than that of non-OSA patients (P=0.049). The retropalatal distance of stoke OSA patients was related with AHI（R=-0.873, P=0.000）. The area under the ROC curve for retropalatal distance as a predictor of presence or absence of OSA was 0.888, which indicated moderate discrimination between groups.　Conclusion　The morphological changes of pharynx are associated with OSA in stroke patients. The retropalatal distance has certain diagnostic value for OSA in stroke patients, and the retropalatal distance is related to the severity of OSA in stroke patients. OSA patients with stroke have higher sub-water test score than non-OSA patients, and OSA in stroke patients may be related to dysphagia.

Key words: Stroke, 　OSA, 　Polysomnogram, 　Pharyngeal morphology

伍琦,张丽霞,张虔,陆甘,袁勇,王彤. 合并及不合并阻塞性睡眠呼吸暂停脑卒中患者的咽部MRI分析[J]. 中国临床解剖学杂志, 2018, 36(5): 507-513.

WU Qi, ZHANG Li-xia, ZHANG Qian, LU Gan, YUAN Yong, WANG Tong. Analysis of pharynx MRI in stroke patients with and without obstructive sleep apnea[J]. Chinese Journal Of Clinical Anatomy, 2018, 36(5): 507-513.

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合并及不合并阻塞性睡眠呼吸暂停脑卒中患者的咽部MRI分析

Analysis of pharynx MRI in stroke patients with and without obstructive sleep apnea

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