阻塞性睡眠呼吸暂停低通气综合征与颈动脉粥样硬化的相关性及持续气道正压通气治疗的作用
조새성수면호흡잠정저통기종합정여경동맥죽양경화적상관성급지속기도정압통기치료적작용
Association of obstructive sleep apnea hypopnea syndrome with carotid atherosclerosis and the efficacy of continuous positive airway pressure treatment
  • 万方数据
    中华医学杂志 중화의학잡지
    National Medical Journal of China
    2015年 34期 2791-2795 ,共5页

    陈碧%张文辉%陈玉玲%胡晨%卞宏%何军%季磊%朱述阳

    진벽%장문휘%진옥령%호신%변굉%하군%계뢰%주술양

    睡眠呼吸暂停,阻塞性%颈动脉疾病%连续气道正压通气%治疗结果 睡眠呼吸暫停,阻塞性%頸動脈疾病%連續氣道正壓通氣%治療結果
    수면호흡잠정,조새성%경동맥질병%련속기도정압통기%치료결과
    Sleep apnea,obstructive%Carotid artery diseases%Continuous positive airway pressure%Treatment outcome
    目的 探讨阻塞性睡眠呼吸低通气暂停综合征(OSAHS)与颈动脉粥样硬化的相关性及持续气道内正压通气(CPAP)治疗的作用.方法 选取2013年3月至2014年12月间在徐州医学院附属医院睡眠中心经多导睡眠图(PSG)确诊的OSAHS患者93例,根据呼吸暂停低通气指数(AHI)分为轻度组(22例)、中度组(37例)、重度组(34例),并选择年龄、性别、体质指数(BMI)相匹配的28名健康体检者为对照组.应用彩色多普勒超声仪检测颈动脉内膜中层厚度(IMT);酶联吸附免疫(ELISA)法测定血浆肿瘤坏死因子-α(TNF-α)、内皮素-1(ET-1)和一氧化氮(NO)的水平,分析OSAHS患者血浆TNF-α、ET-1、NO与颈动脉IMT之间的相关性.并对中、重度组中24例患者进行3个月的CPAP治疗,观察治疗前后相关指标的变化.结果 轻、中、重度组颈动脉IMT依次显著增加,且均显著大于对照组[(0.73 ±0.31)、(0.86 ±0.07)、(1.07±0.14)比(0.65±0.10) mm](均P＜0.05).轻、中、重度组血浆TNF-α和ET-1水平均显著高于对照组[(17.45 ±3.02)、(23.81 ±2.91)、(35.16±3.43)比(12.53±3.48) ng/L和(0.81±0.13)、(1.06±0.21)、(1.66±0.30)比(0.64±0.12)ng/L],而NO水平均显著低于对照组[(35.46±10.12)、(29.32 ±9.47)、(20.16±7.41)比(45.43 ±7.92)μmol/L](均P＜0.05),且各OSAHS组间TNF-α、ET-1和NO水平差异均有统计学意义(均P＜0.05).颈动脉IMT和血浆TNF-α、ET-1水平呈显著正相关(r=0.56、0.51),与血浆NO水平呈明显负相关(r=-0.46)(均P＜0.05).CPAP治疗3个月后,患者血浆TNF-α、ET-1水平均显著低于治疗前[(19.64±5.28)、(0.94±0.21)比(28.72 ±5.36)、(1.36 ±0.36) ng/L],血浆NO水平显著高于治疗前[(33.57 ±6.32)比(24.34±4.46)μmol/L](均P＜0.05);颈动脉IMT较治疗前无明显变化[(0.91 ±0.21)比(0.96±0.14)mm,P＞0.05)].结论 系统性炎症和血管内皮功能紊乱可能在OSAHS患者颈动脉粥样硬化的发生发展过程中起重要作用.短期CPAP治疗可减轻OSHAS患者系统性炎症和血管内皮功能紊乱程度,但未改善颈动脉IMT的增厚.
    목적 탐토조새성수면호흡저통기잠정종합정(OSAHS)여경동맥죽양경화적상관성급지속기도내정압통기(CPAP)치료적작용.방법 선취2013년3월지2014년12월간재서주의학원부속의원수면중심경다도수면도(PSG)학진적OSAHS환자93례,근거호흡잠정저통기지수(AHI)분위경도조(22례)、중도조(37례)、중도조(34례),병선택년령、성별、체질지수(BMI)상필배적28명건강체검자위대조조.응용채색다보륵초성의검측경동맥내막중층후도(IMT);매련흡부면역(ELISA)법측정혈장종류배사인자-α(TNF-α)、내피소-1(ET-1)화일양화담(NO)적수평,분석OSAHS환자혈장TNF-α、ET-1、NO여경동맥IMT지간적상관성.병대중、중도조중24례환자진행3개월적CPAP치료,관찰치료전후상관지표적변화.결과 경、중、중도조경동맥IMT의차현저증가,차균현저대우대조조[(0.73 ±0.31)、(0.86 ±0.07)、(1.07±0.14)비(0.65±0.10) mm](균P＜0.05).경、중、중도조혈장TNF-α화ET-1수평균현저고우대조조[(17.45 ±3.02)、(23.81 ±2.91)、(35.16±3.43)비(12.53±3.48) ng/L화(0.81±0.13)、(1.06±0.21)、(1.66±0.30)비(0.64±0.12)ng/L],이NO수평균현저저우대조조[(35.46±10.12)、(29.32 ±9.47)、(20.16±7.41)비(45.43 ±7.92)μmol/L](균P＜0.05),차각OSAHS조간TNF-α、ET-1화NO수평차이균유통계학의의(균P＜0.05).경동맥IMT화혈장TNF-α、ET-1수평정현저정상관(r=0.56、0.51),여혈장NO수평정명현부상관(r=-0.46)(균P＜0.05).CPAP치료3개월후,환자혈장TNF-α、ET-1수평균현저저우치료전[(19.64±5.28)、(0.94±0.21)비(28.72 ±5.36)、(1.36 ±0.36) ng/L],혈장NO수평현저고우치료전[(33.57 ±6.32)비(24.34±4.46)μmol/L](균P＜0.05);경동맥IMT교치료전무명현변화[(0.91 ±0.21)비(0.96±0.14)mm,P＞0.05)].결론 계통성염증화혈관내피공능문란가능재OSAHS환자경동맥죽양경화적발생발전과정중기중요작용.단기CPAP치료가감경OSHAS환자계통성염증화혈관내피공능문란정도,단미개선경동맥IMT적증후.
    Objective To evaluate the association of obstructive sleep apnea hypopnea syndrome (OSAHS) with carotid atherosclerosis and the efficacy of continuous positive airway pressure (CPAP) treatment.Methods A total of 93 OSAHS patients diagnosed by polysomnography (PSG) were selected from Sleep Disorders Center at Affiliated Hospital of Xuzhou Medical College between March 2013 and December 2014.Based on the results of apnea-hypopnea index (AHI),they were divided into mild (n =22),moderate (n =37),and severe OSAHS group (n =34).Meanwhile,28 healthy adult individuals matched for age and body mass index (BMI) were enrolled as the control group.The carotid intima-mesa thickness (IMT) was measured by color Doppler uhrasonography,and plasma levels of tumor necrosis factor-α (TNF-α),endothelin-1 (ET-1) and nitric oxide (NO) were determined by Enzyme-Linked Immunosorbent Assay (ELISA).The correlations between carotid IMT and plasma levels of TNF-α,ET-1 and NO were analyzed.A total of 24 patients with moderate to severe OSAHS underwent CPAP treatment and the carotid IMT,plasma levels of TNF-α,ET-1 and NO were compared before and after CPAP treatment.Results OSAHS patients had significant increase of carotid IMT with the increasing disease severity,and the carotid IMT in mild,moderate and severe OSAHS groups were all significantly higher than that in the control group ((0.73 ±0.31),(0.86 ±0.07),(1.07±0.14) vs (0.65 ±0.10) mm,allP＜0.05).The plasma levels of TNF-α and ET-1 in mild to severe OSAHS group were significantly higher than those in controls ((17.45 ±3.02),(23.81 ±2.91),(35.16 ±3.43) vs (12.53 ±3.48) ng/L and (0.81 ±0.13),(1.06 ±0.21),(1.66 ±0.30) vs (0.64 ±0.12) ng/L,all P ＜0.05),whereas plasma levels of NO in the three OSAHS groups were significantly decreased compared with the control group ((35.46 ± 10.12),(29.32 ± 9.47),(20.16 ± 7.41) vs (45.43 ± 7.92) μmol/L,all P ＜ 0.05).Furthermore,there were significant differences in plasma levels of TNF-α,ET-1 and NO among the three OSAHS groups (all P ＜0.05).Carotid IMT was positively correlated with plasma TNF-α and ET-1 (r =0.56 and 0.51) and negatively correlated with plasma NO (r =-0.46) (all P ＜ 0.05).After 3 months of CPAP treatment,plasma levels of TNF-α and ET-1 in OSAHS patients were significantly reduced ((19.64 ± 5.28),(0.94 ±0.21) vs (28.72 ± 5.36),(1.36 ± 0.36) ng/L),and plasma NO was markedly increased ((33.57 ±6.32) vs (24.34 ± 4.46) μmol/L,all P ＜ 0.05).However,CPAP treatment did not have a significant effect on carotid IMT ((0.91 ±0.21) vs (0.96 ±0.14) mm),P＞O.05).Conclusions Systemic inflammation and vascular endothelial dysfunction may play an important role in pathogenesis and development of carotid artery atherosclerosis in OSAHS.Short-term CPAP therapy alleviates systemic inflammation and improves endothelial function,but does not influence the increased carotid IMT in OSAHS patients.
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