一氧化氮和降钙素基因相关肽在阻塞性睡眠呼吸暂停低通气综合征患者咽组织及血浆中的分布及变化

Distributings and changes of NO and calcitonin gene-related peptide in pharyngeal tissues and plasma in obstructive sleep apnea and hypopnea syndrome

目的 了解NO、降钙素基因相关肽(calcitonin gene-related peptide,CGRP)的含量与阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea and hypopnea syndrome,OSAHS)的关系。方法 用放射免疫法和酶还原法检测血浆中CGRP和NO含量;用免疫组化的方法观察一氧化氮合酶(nitric oxide synthase,NOS)、CGRP在咽部软组织中的分布、变化情况。结果 咽部软组织匀浆NO含量平均值为重度OSAHS组(20例)高于正常对照组(20例),P<0.001,CGRP含量平均值为重度OSAHS组低于正常对照组,P<0.001。血浆NO含量平均值(每组各20例)正常对照组高于中、重度OSAHS组,P<0.001;重度OSAHS行UPPP术后痊愈组与轻度OSAHS组相当,P>0.05;血浆CGRP含量平均值正常对照组和UPPP术后痊愈组高于中、重度OSAHS组,P<0.001;正常对照组与UPPP术后痊愈组差异无显著性,P>0.05。NOS免疫组化标记观察(各20例):重度OSAHS组黏膜鳞状上皮表达弱阳性或为阴性,部分唾液腺上皮呈强阳性表达或唾液腺上皮散在强阳性表达,横纹肌、血管壁、小血管壁呈阳性,少数腺体间导管上皮有局灶性阳性;对照组仅见局部导管上皮局灶性阳性反应,横纹肌细胞节段性片状阳性。CGRP免疫组化标记观察:重度OSAHS组黏膜鳞状上皮及唾液腺腺泡上皮及导管上皮细胞全部阴性。

Objective To explore the distributings and changes of nitric oxide ( NO) and calcitonin gene-related peptide ( CGRP) in obstructive sleep apnea and hypopnea syndrome ( OSAHS) . Methods This study investigated the content of NO and CGRP in plasma and in pharyngeal tissues of OSAHS subjects. Moreover, the distribution of NOS and CGRP in pharyngeal tissues was researched using method of immunohistochemistry. Results (1)Plasma NO level in control group was higher than in mild OSAHS group and in serious OSAHS group,P < 0. 001. There was a significant increase in plasma CGRP after UPPP(P < 0. 001) , and the plasma CGRP level in control group was as high as that in after UPPP group ( P > 0. 05 ) NO level in pharyngeal tissue of OSAHS increased significantly, P < 0. 001) , but CGRP level decreased markedly, P< 0. 001. (2)Immunohistochemistry change about NOS :there was a feeble positive expression in mucosa squamous epithelium of OSAHS and powerful positive expression in some salivary glandular epithelium, striated muscle cells, vascular wall /small vascular wall and epithelium of glandular duct of OSAHS. (3)Immunohistochemistry change about CGRP:There were diffusible positive markings in striated muscle cells and most cilium columnar epithelium in OSAHS, and negative expressions in other sites. Conclusions (1)Circulating NO and CGRP are suppressed in OSAHS, and reversible promptly after UPPP. Further more, The content of NO in pharyngeal tissues increases significantly and that of CGRP decreases markedly. (2)The distribution of NOS and CGRP in pharyngeal tissue changes apparently according to sites.