CAJ | 학술논문

目的通过对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并冠心病患者血清高半胱氨酸(HCY)和C-反应蛋白(CRP)水平的检测分析,探讨HCY、CRP与OSAHS及OSAHS合并冠心病的相关性.方法将研究对象分为正常对照组(30例)、OSAHS组(36例)、OSAHS合并冠心病组(25例),采用化学发光法检测血清HCY和放射免疫法检测血清CRP,并比较3组HCY、CRP的水平；将OSAHS患者按病情再分为轻、中、重度3组,进一步对其冠心病的发生、血清HCY和CRP的水平进行比较；同时比较OSAHS和OSAHS合并冠心病两组患者呼吸暂停低通气指数(AHI)、血氧饱和度(SaO2)等睡眠呼吸监测指标.结果①血清HCY、CRP水平:正常对照组、OSAHS组、OSAHS合并冠心病组3组间有显著差异(FHCy=15.80,FCRP=19.21,P均＜0.01)；OSAHS 合并冠心病组显著高于OSAHS组(tHCY=4.74,tCRP=5.14,P均＜0.01)；OSAHS组显著高于正常对照组(tHCY=7.31,tCRP=8.17,P均＜0.01).②OSAHS病情重度患者冠心病发生显著高于轻、中度组(x2=6.96,x2=4.18,P均＜0.05)；随着OSAHS病情的加重,血清HCY、CRP水平显著上升(FHCY=16.38,FCRP =12.97,P均＜0.01).③单纯OSAHS组及OSAHS合并冠心病组间AHI、SaO2等睡眠呼吸监测指标有显著差异(tAHI=5.46,SaO2＜90％占总睡眠时间的百分比:t=1.88,P均＜0.01；呼吸障碍事件总时间占总睡眠时间的百分比:t=2.47,P＜0.05；最低SaO2:t=4.68,平均最低SaO2:t=3.65,P均＜0.01；呼吸障碍事件最长时间:t=4.73,P＜0.01).结论 OSAHS患者缺氧导致应激引起HCY、CRP水平升高,从而进一步促进冠心病的发生和发展.
목적 통과대조새성수면호흡잠정저통기종합정(OSAHS)합병관심병환자혈청고반광안산(HCY)화C-반응단백(CRP)수평적검측분석,탐토HCY、CRP여OSAHS급OSAHS합병관심병적상관성.방법 장연구대상분위정상대조조(30례)、OSAHS조(36례)、OSAHS합병관심병조(25례),채용화학발광법검측혈청HCY화방사면역법검측혈청CRP,병비교3조HCY、CRP적수평；장OSAHS환자안병정재분위경、중、중도3조,진일보대기관심병적발생、혈청HCY화CRP적수평진행비교；동시비교OSAHS화OSAHS합병관심병량조환자호흡잠정저통기지수(AHI)、혈양포화도(SaO2)등수면호흡감측지표.결과①혈청HCY、CRP수평:정상대조조、OSAHS조、OSAHS합병관심병조3조간유현저차이(FHCy=15.80,FCRP=19.21,P균＜0.01)；OSAHS 합병관심병조현저고우OSAHS조(tHCY=4.74,tCRP=5.14,P균＜0.01)；OSAHS조현저고우정상대조조(tHCY=7.31,tCRP=8.17,P균＜0.01).②OSAHS병정중도환자관심병발생현저고우경、중도조(x2=6.96,x2=4.18,P균＜0.05)；수착OSAHS병정적가중,혈청HCY、CRP수평현저상승(FHCY=16.38,FCRP =12.97,P균＜0.01).③단순OSAHS조급OSAHS합병관심병조간AHI、SaO2등수면호흡감측지표유현저차이(tAHI=5.46,SaO2＜90％점총수면시간적백분비:t=1.88,P균＜0.01；호흡장애사건총시간점총수면시간적백분비:t=2.47,P＜0.05；최저SaO2:t=4.68,평균최저SaO2:t=3.65,P균＜0.01；호흡장애사건최장시간:t=4.73,P＜0.01).결론 OSAHS환자결양도치응격인기HCY、CRP수평승고,종이진일보촉진관심병적발생화발전.
Objective To explore the relationship between homocysteine(HCY) and C-reactive protein(CRP) in obstructive sleep apnea/hypopnea syndrome(OSAHS) patients and OSAHS patients compli cated with coronary heart disease by detecting the scrum level of HCY and CRP on the mechanism of OSAHS complicated with coronary heart disease.Methods Ninety-one patients were divided into three groups,30 patients as control group,36 patients as OSAHS group,and 25 patients as OSAHS complicated with CHD group.Serum HCY level was detected through chemiluminescence.Serum CRP level was detected through radioimmunity.The serum level of HCY and CRP was compared among these groups.OSAHS patients were divided into mild OSAHS subgroup,moderate OSAHS subgroup and severe OSAHS subgroup.The morbidity rate of CHD and the serum level of HCY and CRP were compared among these subgroups.Meanwhile the parameters of polysomnogram such as activity apnea-hypopnea index(AHI) and blood oxygen saturation (SaO2) were compared between OSAHS group and OSAHS complicated with coronary heart disease group.Results ① There was significant difference among the serum level of HCY and CRP of control group,OSAHS group and OSAHS complicated with CHD group (FHCY=15.80,FCRP=19.21,P all＜0.01 ).The serum level of HCY and CRP of OSAHS complicated with CHD group was significantly higher than that of OSAHS group (tHCY=4.74,tCRP=5.14,P all ＜0.01).The serum level of HCY and CRP of OSAHS group was significantly higher than that of control group (tHCY=7.31,tCRP=8.17,P all ＜0.01).②) The morbidity rate of CHD of severe OSAHS subgroup was significantly higher than that of mild OSAHS subgroup and that of moderate OSAHS subgroup (x2=6.96,x2=4.18,P＜0.05 ).The serum level of HCY and CRP were correlated with the severity of OSASH (FHCY=16.38,FCRP=12.97,Pall＜0.01 ).③ There were significant difference between apnea hyponea index and SaO2 of OSAHS group and OSAHS complicated with CHD group (tAHI=5.46,percentage of SaO2 ＜90％ in total sleep time:t=1.88,P all＜0.01 ; percentage of disordered breathing event in the total sleep time:t=2.47,P＜0.05; lowest SaO2:t=4.68,average lowest SaO2:t=3.65,longest duration of disordered breathing events:t =4.73,P all＜0.01 ).Conclusion The serum level of HCY and CRP rose because of hypoxia in OSAHS patients,and might play an important role in the mechanism of OSAHS complicated with CHD.