阻塞性睡眠呼吸暂停低通气综合征患者颞横回氢质子波谱研究

~1H Magnetic Resonance Spectroscopy Study of Auditory Cortex Metabolism in Patients with Obstructive Sleep Apnoea Hypopnea Syndrome

宋冬梅;张继华;刘涛;吕欣;薛静;王宝山;

1:河北医科大学第一医院耳鼻咽喉科

摘要
目的探讨磁共振氢质子波谱(1 H—MRS)用于阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者听皮层神经细胞损伤的预警作用。方法随机抽取经PSG监测确诊的OSAHS患者95例,根据纯音听阈将其分为OSAHS并双侧耳聋组(18例)、OSAHS并单侧耳聋组(27例,左15例,右12例)、单纯OSAHS组(50例),选择健康志愿者15例为正常对照组,各组分别行双侧颞横回听皮层1 H—MRS检测,根据神经代谢产物其峰下面积计算N-乙酰天门冬氨酸/肌酸(NAA/Cr)、胆碱/肌酸(Cho/Cr)、肌醇/肌酸(mI/Cr)、N-乙酰天门冬氨酸/胆碱(NAA/Cho);用ROC曲线面积>50%为判断上述各组指标诊断早期OSAHS并感音神经性听力损失的灵敏度及特异度。结果与正常对照组相比,OSAHS组以及OSAHS并耳聋组NAA/Cho降低(P<0.05),Cho/Cr、mI/Cr升高(P<0.05),OSAHS并双侧耳聋组NAA/Cho低于OSAHS组(P<0.05),而OSAHS并单侧耳聋组患侧与健侧NAA/Cho差异无统计学意义(P>0.05);NAA/Cho的ROC曲线下面积为73%,其余指标ROC曲线下的面积均<50%。结论 NAA/Cho有可能作为判定OASHS患者合并感音神经性听力损失的早期听皮层代谢预警指标。
关键词
呼吸睡眠暂停低通气综合症;感音神经性聋;磁共振氢质子波谱
基金项目(Foundation):
作者
宋冬梅;张继华;刘涛;吕欣;薛静;王宝山;
参考文献

1 Ralls FM,Grigg-Damberger M.Roles of gender,age,race/ethnicity,and residential socioeconomics in obstructive sleep apnea syndromes[J].Curr Opin Pulm Med,2012,18:568.

2 Chau JK,Cho JJ,Fritz DK.Evidence-based practice:management of adult sensorineural hearing loss[J].Otolaryngol Clin North Am,2012,45:941.

3 孔峰,王宁宇,杨惠婕,等.阻塞性睡眠呼吸暂停低通气综合征的听觉功能评价[J].听力学及言语疾病杂志,2004,12:161.

4 Wang B,Yan B,Song D,et al.Chronic intermittent hypoxia down-regulates endothelial nitric oxide synthase expression by an NF-κB-dependent mechanism[J].Sleep Med,2013,14:165.

5 陈贤明,梁永辉,陈自谦,等.突发性聋患者急性期听皮层代谢1 H-MRS研究[J].听力学及言语疾病杂志,2011,19:525.

6 中华医学会呼吸病学分会睡眠呼吸障碍学组,阻塞性睡眠呼吸暂停低通气综合征诊疗指南(2011年修订版)[J].中华结核和呼吸杂志,2012,35:9.

7 李富德,梁瑞敏,陈晨.急性低频感音神经性聋临床发病特征和诊断[J].听力学及言语疾病杂志,2008,16:285.

8 Haga KK,Khor YP,Farrall A,et al.A systematic review of brain metabolite changes,measured with 1 H-magnetic resonance spectroscopy,in healthy aging[J].Neurobiol Aging,2009,30:353.

9 Bertolino A,Sciota D,Brudaglio F,et al.Working memory deficits and levels of N2acetylaspartate in patients with schizophreniform disorder[J].Am J Psychiat,2003,160:4 832.

10 陈贤明,窦晓晴,梁永辉,等.老年性聋患者听皮层磁共振波谱分析[J].中华耳鼻喉头颈外科杂志,2012,47:852.