持续气道正压通气治疗对阻塞性睡眠呼吸暂停低通气综合征患者8-异前列腺素和超敏C反应蛋白的影响被引量：19

The effects of continuous positive airway pressure ventilation on hypersensitive C reaction protein and 8-isoprostane in patients with obstructive sleep apnea hypopnea syndrome

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摘要目的观察持续气道正压通气治疗对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者8-异前列腺素和超敏C反应蛋白（CRP）的影响.方法选2013年1-3月在首都医科大学附属北京世纪坛医院干部医疗暨老年医学科进行多导睡眠监测（PSG）并确诊的78例男性OSAHS患者（OSAHS组）,另选排除OSAHS健康人40例为对照组,依据呼吸暂停低通气指数（AHI）及夜间脉搏血氧饱和度（SpO2）将患者分为轻度、中度、重度OSAHS,OSAHS组患者予以持续气道正压通气治疗.测两组受试者睡眠前后及持续气道正压通气治疗后血、尿8-异前列腺素及血超敏CRP.结果（1）OSAHS组睡眠前血8-异前列腺素水平为（273.80±55.83） ng/L,睡眠后为（337.18±56.28） ng/L;睡眠前尿8-异前列腺素水平为（35.65±7.08） ng/L,睡眠后为（48.30±14.17） ng/L;睡眠前血超敏CRP水平为（7.63 ±6.10） μg/L,睡眠后为（9.68±8.55） μg/L;睡眠前后比差异有统计学意义（P均＜0.05）.（2）OSAHS组睡眠前血、尿8-异前列腺素及超敏CRP水平与对照组[（264.14±33.61） μg/L、（32.77 ±9.61） μg/L、（4.56 ±2.43） μg/L]比差异有统计学意义（P均＜0.05）.OSAHS组睡眠后血、尿8-异前列腺素及超敏CRP水平与对照组[（284.27±47.51） ng/L、（31.13±8.24） ng/L、（4.33±2.08） μg/L]比差异有统计学意义（P均＜0.05）.（3）OSAHS组轻度、中度、重度患者睡眠后血、尿8-异前列腺素及超敏CRP水平差异无统计学意义（P＞0.05）.（4）相关性分析：OSAHS组患者睡眠后尿8-异前列腺素水平与超敏CRP呈正相关（r=0.498,P＜0.01）,8-异前列腺素和超敏CRP水平与AHI有相关性（r分别为0.479、0.550,P均＜0.01）,8-异前列腺素、超敏CRP水平与SpO2＜ 90％累积时间占总睡眠时间百分比有相关性（r分别为0.413、0.502,P均＜0.01）.（5）OSAHS组患者经持续气道正压通气治疗后血、尿8-异前列腺素及超敏CRP水平下降,与治疗前比差异有统计学意义（P均＜0.05）.结论 OSAHS患者长期夜间间歇缺氧引起氧化应激反应增强,炎性介质水平升高,且两者间存在相关性,互相促进,进一步加重缺氧引起的各器官功能障碍.持续气道正压通气治疗可降低氧化应激反应及炎性介质生成. Objective To observe the effect of continuous positive airway pressure ventilation on hypersensitive C reaction protein （hsCRP） and 8-isoprostane in patients with obstructive sleep apnea hypopnea syndrome （OSAHS）.Methods A total of 78 OSAHS patients were enrolled and monitored by polysomnography （PSG） in January to March,2013.Another 40 healthy persons were chosen as controls during the same time.According to apnea hypopnea index（AHI） and oxygen saturation,the patients were divided into mild,moderate and severe groups.Blood and urinary 8-isoprostane and hsCRP levels were detected before and after monitoring.After continuous positive airway pressure treatment for three months,blood and urinary 8-isoprostane and hsCRP were also detected in three groups.Results （1） In OSAHS patients,blood 8-isoprostane levels before and after sleep monitoring were （273.80 ± 55.83）ng/L and （337.18 ± 56.28） ng/L urinary 8-isoprostane （35.65 ± 7.08） ng/L and （48.30 ± 14.17） ng/L,hsCRP （7.63 ± 6.10） μg/L and （9.68 ± 8.55） μg/L,respectively.Each parameter reached a significant difference before and after sleep（P 〈 0.05）.（2） The levels of blood CRP and urinary 8-isoprostane in the control group before sleep were （4.56 ± 2.43） μg/L,（264.14 ± 33.61） ng/L,（32.77 ± 9.61） ng/L,after sleep were （4.33 ± 2.08） μg/L,（284.27 ± 47.51） ng/L,（31.13 ± 8.24） ng/L.All the levels were less than those of OSAHS group （P 〈 0.05）.（3） The levels of blood 8-isoprostane in mild,moderate and severe groups after monitoring were （308.16 ± 53.48） ng/L,（327.36 ± 59.05） ng/L,（340.39 ± 55.31） ng/Lrespectively,and urinary 8-isoprostane were （35.23 ± 11.28） ng/L,（38.30 ± 10.89） ng/L,（44.57 ±12.69） ng/L,hsCRP were （5.63 ± 4.26） μg/L,（6.96 ± 4.43） μg/L,（8.92 ± 7.84） μg/L.None of these three parameters showed significant difference between the three groups （P 〉 0.05）.However,compared with the control group,blood and urine 8-isoprostane and hsCRP levels of any groups had significant differences（all P values 〈 0.05）.（3） There was no significant difference in the levels of hsCRP and 8-isoprostane after sleep between the three groups in OSAHS （P 〉 0.05）.（4） Urinary 8-isoprostane level after PSG was positively correlated with hsCRP （r =0.498,P 〈0.01）.Either 8-isoprostane or hsCRP level was correlated with AHI （r =0.479,r =0.550;P 〈 0.01）.8-isoprostane and hsCRP levels were positively correlated with time of blood hemoglobin oxygen saturation below 90% （r =0.413,r =0.502;P 〈 0.01）.（5） After continuous positive airway pressure treatment,the levels of 8-isoprostane and hsCRP both in blood or urine were decreased in the three groups of OSAHS patients （P 〈 0.05）.Conclusions Long term intermittent hypoxia in patients with OSAHS results in enhanced oxidative stress reaction and over-generated inflammatory mediators.There is a positive correlation between oxidative stress and inflammatory mediators,which promotes each other,leading to the organ dysfunction induced by hypoxia.

作者钱进马晓蓉潘磊张振宁许亚丽王勇

机构地区首都医科大学附属北京世纪坛医院干部医疗暨老年医学科

出处《中华内科杂志》 CAS CSCD 北大核心 2015年第7期633-637,共5页 Chinese Journal of Internal Medicine

基金中国铁路总公司科技研究开发计划课题（20132003-C）

关键词睡眠呼吸暂停阻塞性缺氧异前列腺素 C反应蛋白质 Sleep apnea,obstructive Anoxia Isoprostanes C-reactive protein

分类号 R766 [医药卫生—耳鼻咽喉科]

作者简介通信作者：王勇，Email：wangyong7096@aliyun．com

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