锥形束CT三维头影测量评价青年鼾症患者颅面特征及气道容积

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摘要目的：用锥形束CT（CBCT）三维头影测量评估青年鼾症患者颅面部形态及气道容积。方法：采用整群抽样方法对温州医科大学3 300名青年学生做打鼾情况调查，并为重度打鼾者102人做Epworth嗜睡量表，嗜睡评分大于9分的28人做睡眠呼吸监测，检测结果不能诊断为阻塞性睡眠呼吸暂停低通气综合征者定为鼾症患者，为鼾症组，共20人。4位以上室友确认无打鼾者为对照组，共20人。2组在同等条件下拍摄CBCT，3位正畸医师利用Dolphin软件对CBCT影像进行三维头影测量和气道容积测量，每人测2次，间隔1周。计算组内相关系数（ICC）评价6次测量之间的可靠度。用t检验分析鼾症组与对照组之间的差别。结果：鼾症组BMI（P=0.028）和颈围（P=0.043）大于对照组，差异有统计学意义。骨性指标中鼾症组N-S-Ar角（P=0.042）和Nasal floor to FH角（P＜0.001）大于对照组，差异有统计学意义；鼾症组S-N（P=0.039）、S-Ba（P=0.009）和N-ANS（P=0.022）小于对照组，差异有统计学意义。代表气道间隙的指标UP-PhW（P=0.001）、UT-PhW（P=0.037）、PP-SPU（P=0.006）、PNS-SPU（P=0.004）、SAM-SPM（P=0.009）、SAL-SPL（P=0.009）、PNR（P=0.011）在鼾症组均小于对照组，差异有统计学意义。鼾症组鼻咽气道体积（P=0.002）、腭咽气道体积（P=0.003）、舌咽气道体积（P=0.003）、总气道体积（P=0.006）均小于对照组，差异有统计学意义。结论：青年鼾症的主要特征是鼻腔骨性结构较小，咽腔狭窄，气道狭窄，以及肥胖和颈围较大。

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	秦化祥
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关键词 ：青年, 鼾症, 锥形束CT, 三维头影测量, 颅面特征, 气道

Abstract：Objective: To estimate the craniofacial morphology and airway volume of young snoring patients by CBCT 3D cephalometry. Methods: A cluster sampling method was used to investigate the snoring status of 3 300 young students in Wenzhou Medical University. According to the degree of snoring, 102 subjects with severe snoring were selected to do Epworth sleepiness score, and 28 subjects scored higher than 9 did polysomnography examination (PSG). According to the PSG results, 20 subjects with snoring but not OSAHS were generalized as snoring group, and another 20 subjects, who were confirmed by himself and four of his roommates with no snoring, were defined as control group. CBCT was taken under the same conditions in both groups. Three orthodontists used Dolphin software to perform three-dimensional cephalometric and airway volume measurements on CBCT images. Each person was measured twice, one week apart. Intra-group correlation coefficient (ICC) was calculated to evaluate the reliability between six measurements, and t test was used to analyze the difference between snoring group and control group. Results: The BMI (P=0.028) and neck circumference (P=0.043) in the snoring group were larger than those of the control group. The N-S-Ar angle (P=0.042) and Nasal floor to FH angle (P<0.001) in the snoring group were larger than those in the control group, and the S-N (P=0.039), S-Ba (P=0.009) and N-ANS (P=0.022) in the snoring group were smaller than those in the control group. UP-PhW (P=0.001), UT-PhW (P=0.037), PP-SPU (P=0.006), PNS-SPU (P= 0.004), SAM-SPM (P=0.009), SAL-SPL (P=0.009), PNR (P=0.011) representing the airway space in the snoring group were significantly smaller than the control group. The airway volume of the snoring group was significantly smaller than the control group. Conclusion: The main craniofacial characteristics of young snoring people include small nasal cavity, narrow pharyngeal cavity, narrow airway, obesity and larger neck circumference.

Key words： young snoring cone beam computed tomography 3D cephalometric craniofacial charact-eristics airway

收稿日期: 2018-05-11

基金资助:温州市科技计划项目（Y20130229）。

通讯作者: 胡荣党，教授，Email：hurongdang@yahoo.com.cn

作者简介: 秦化祥（1983-），男，安徽亳州人，主治医师，硕士。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2018/V48/I12/903

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