持续气道正压通气对有阻塞性睡眠呼吸暂停低通气综合征的冠心病患者细胞黏附分子及P-选择素水平的影响

Effects of continuous positive airway pressure ventilation on cell adhesion molecules and P-selectin in coronary heart disease patients with obstructive sleep apnea-hypopnea syndrome

目的探讨存在阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的冠心病患者外周血白细胞黏附分子β2整合素和血清可溶性细胞间黏附分子1(sICAM1)、血管细胞黏附分子1(sVCAM1)、P选择素的水平以及持续气道正压通气治疗后的变化。方法对住院的76例冠心病患者用多导睡眠监测确定是否存在OSAHS,并与23例对照组一起采用流式细胞仪技术检测外周血白细胞β2整合素、sICAM1和sVCAM1水平,采用酶联免疫吸附法检测P选择素。对存在中、重度OSAHS的41例冠心病患者使用自动调节持续气道正压通气进行治疗1周。治疗结束后,再次检测上述指标。结果76例冠心病患者中,41例呼吸暂停低通气指数(AHI)≥15,35例AHI<15。冠心病组细胞黏附分子及P选择素水平明显高于对照组;AHI≥15的冠心病患者β2整合素、sICAM1和sVCAM1、P选择素的表达均显著高于AHI<15的冠心病组,在接受持续气道正压通气治疗后这些指标明显下降。结论冠心病患者存在明显外周血管炎性损伤,OSAHS可能加剧冠心病的炎性损伤。对于存在中、重度OSAHS的冠心病患者应当使用持续气道正压通气治疗。

Objective To investigate changes in levels of β2- integrin , serum soluble intercellular adhesion molecule-1 （ sICAM-1 ） , vascular cell adhesion molecule-1 （ sVCAM-1 ）, and P-selectin in coronary heart disease （CHD） patients with obstructive sleep apnea-hypopnea syndrome （OSAHS） after treatment of continuous positive airway pressure （CPAP） ventilation. Methods OSAHS was detected in all 76 hospitalized CHD patients with polysomnography （PSG）. Levels of β2-integrin, sICAM-1, sVCAM-1 were determined by fluorescence flow cytometry and P-selectin level was measured by enzyme linked immunosorbent assay （ELISA） in all 76 CHD cases and 23 normal controls. All the CHD patients with moderate or severe OSAHS were treated with auto-CPAP ventilation for one week and all parameters mentioned above were measured again after treatment. Results Forty-one of 76 （53.9%） cases of CHD had apnea-hypopnen index（AHI） ≥ 15. Levels of β2- integrin, sICAM-1, sVCAM-1 and P-selectin were all significantly higher in CHD patients than those in controls （ P 〈 0. 01 ） , and significantly higher in CHD patients with AHI≥15 than those with AHI 〈 15 （P 〈0.01 ）. Levels of β2-integrin, sICAM-1, sVCAM-1 and P-selectin decreased significantly in CHD patients with AHI ≥ 15 after auto-CPAP ventilation. Conclusions Significantly inflammatory impairement in peripheral vessels could be found in patients with CHD and OSAHS may exacerbate this inflammatory process. CPAP ventilation should be used for CHD patients with moderate or severe OSAHS.