持续气道正压通气对冠心病合并阻塞性睡眠呼吸暂停综合征患者细胞黏附分子及P-选择素水平的影响

Effects of Continuous Positive Airway Pressure on Adhesion Molecules and P-selectin in Coronary Heart Disease Patients with Obstructive Sleep Apnea Syndrome

目的:探讨存在阻塞性睡眠呼吸暂停综合征(OSAS)的冠心病(CHD)患者外周血白细胞黏分子β2整合素和血清可溶性细胞间黏附分子-1(sICAM-1)、血管细胞黏附分子-1(sVCAM-1)、P-选择素的变化以及短期进行持续气道正压通气(CPAP)治疗的影响。方法:通过多导睡眠图(PSG)评价CHD患者是否存在OSAS,对76例CHD患者及23例对照组采用流式细胞仪技术检测外周血白细胞β2整合素、血清sICAM-1和sVCAM-1水平,并采用ELISA法检测P-选择素的表达。对于存在OSAS的CHD患者使用Auto-CPAP进行治疗,时间1周。治疗结束后,再次检测上述指标。结果:76例CHD患者中,41例存在OSAS,36例不存在OSAS。CHD组细胞黏附分子以及P-选择素水平明显高于对照组。存在OSAS的CHD患者外周血白细胞β2整合素、血清sICAM-1和sVCAM-1、P-选择素的表达显著高于不存在OSAS的CHD组,而在经CPAP治疗后明显下降。结论:CHD患者存在明显外周血管炎性损伤,OSAS可能够加剧CHD的炎性损伤,而对于存在OSAS的CHD患者应当使用持续气道正压通气治疗。

Objective： To investigate the changes and significance of periheral blood adhesion molecules and P-selectin in coronary heart disease patients with obstructive sleep apnea syndrome （OSAS） and to evaluate the effect of treatment of continuous positive airway pressure（CPAP）. Methods： All patients with coronary heart disease had undergone a polysomnography（PSG） study to identi- fy the presence of OSAS. The expression of β2-intergrin on neutropnils, serum soluble intercellular adhesion molecule-1 （sICAM-1） and soluble vascular cell adhesion molecule-1 （sVCAM-1） level were determined by using flow cytometry in 76 cases of coronary heart disease and 23 cases of normal subjects. P-selectin levels were measured in all subjects by enzyme linked immunosorbent assay（ELISA）. After PSG, the coronary heart disease patients with OSAS were treated by auto-CPAP for a week and all parameters were measured again. Results： There were 41/76 （53.9%） coronary heart disease patients with OSAS. The mean fluorescence intensity of β2-intergrin, sICAM-1,sVCAM-1 and the average level of P-selectin were significantly higher in coronary heart disease patients than in the controls（all P〈0.01）. The levels of adhesion＇molecules and P- selectin were significantly higher in patients with OSAS and coronary heart disease than those in coronary heart disease subjects without OSAS. Auto-CPAP significantly decreased the levels of adhesion molecules and P-selectin in patients with OSAS and coronary heart disease. Conclusion： Vessels were significantly impaired by inflammation in patients with coronary heart disease and obstructive sleep apnea syndrome may promote this inflammatory process. Continuous positive airway pressure is a useful treatment for coronary heart disease patients with OSAS.