阻塞性睡眠呼吸暂停低通气综合征患者的血清瘦素水平

Serum leptin level in patients with obstructive sleep apnea-hypopnea syndrome

目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血清瘦素水平以及悬雍垂腭咽成形术对瘦素水平的影响。方法对61例经过多道睡眠监测确诊的OSAHS患者行改良悬雍垂腭咽成形术。采用放射免疫测定法,测定OSAHS患者术前、术后以及20例年龄、体重指数相近的单纯打鼾患者(对照组)的血清瘦素水平,分析瘦素与呼吸暂停及低通气指数(AHI)、体重指数(BMI)的关系以及术前、术后血清瘦素水平的变化。结果OSAHS患者与对照组的血清瘦素水平( x±s)分别为(15 3±8 0)μg/L、(6 1±3 1)μg/L,差异有统计学意义(P<0 05)。在OSAHS患者中,轻度、中度、重度患者的血清瘦素水平分别为(9 8±2 1)μg/L、(14 2±6 7)μg/L、(19 3±7 9)μg/L,血清瘦素水平与阻塞程度呈正相关(r=0 68,P<0 01 )。61例中52例有效者术后6个月血清瘦素水平(7 0±1 3)μg/L,与术前(15 2±3 9)μg/L相比,差异有统计学意义(P<0 01),这种差异与BMI无关,而无效者(9例)血清瘦素水平无明显变化。结论OSAHS患者血清瘦素水平增高,且瘦素水平与睡眠呼吸暂停的程度有密切联系;悬雍垂腭咽成形术治疗有效者血清瘦素水平下降。呼吸暂停有可能是导致OSAHS患者体内瘦素水平增高的重要因素。

Objective To investigate the effect of uvuplopalatopharyngoplasty on changes of serum leptin levels in patients with obstructive sleep apnea-hypopnea syndrome(OSAHS). Methods Sixty-one patients with OSAHS diagnosed by polysomnography were treated with uvuplopalatopharyngoplasty. Pretreatment and post-uppp serum leptin concentrations in patients with OSAHS and in BMI-matched controls were measured by radioimmunoassay. Correlations between leptin concentrations and AHI, BMI were analyzed. Results The concentrations of leptin in patients with OSAHS were higher than that in controls ^(P<0.05). Mean levels(±s) of leptin were (9.8±2.1) μg/L, (14.2±6.7) μg/L, and (19.3±7.9) μg/L in patients with severe, mediate and mild obstructive sleep apnea, respectively. Serum leptin levels corelated positively with the degree of OSAHS as reflected by AHI(r=0.68, P<0.01). The leptin concentration of 51 responders after 6 months were significantly decreased (P<0.01) than that of pre-operation. However, the difference of leptin concentration between pre-operation and post operation was not significant in 9 non-responders (P>0.05). Conclusions There are higher leptin concentrations in patients with OSAHS, which are significantly correlated to the severity of disease. Serum leptin levels in responders decreased significantly after uvuplopalatopharyngoplasty. OSAHS may influence the leptin system,resulting in increased serum leptin level.