阻塞性睡眠呼吸暂停低通气综合征患者CD4^+及CD8^+细胞的活化

The change of the activated CD4^+ and CD8^+ cells in patients with obstructive sleep apnea hypopnea syndrome

目的探讨CD4+及CD8+细胞在阻塞性睡眠呼吸暂停低通气综合征(OSAHS)发病中的作用。方法研究对象均进行多导睡眠监测(PSG),随机抽取研究对象,分为正常对照组、轻度OSAHS组、中度OSAHS组和重度OSAHS组各29例,16例重度OSAHS患者同时进行nCPAP治疗1月。流式细胞仪测定CD4+和CD8+细胞分别占总T细胞的百分比,活化的CD4+及CD8+细胞分别占全部CD4+和CD8+细胞的百分比。结果①正常对照组、轻度、中度及重度OSAHS患者,CD4+占总T细胞的百分比分别为71.0%±8.0%、65.0%±4.5%、54.2%±6.8%及43.0%±4.7%;CD8+占总T细胞的百分比分别为24.4%±8.7%、30.3%±5.0%、40.4%±7.0%和49.4%±6.7%。CD4+细胞的活化率分别为4.4%±0.5%、5.0%±0.6%、8.1%±0.5%和9.7%±0.7%;CD8+细胞的活化率分别为7.5%±0.7%、8.2%±0.5%、12.0%±1.1%和13.3%±1.1%。两两对比差异有显著性,P均<0.001。重度OHAHS患者nCPAP治疗后,CD4+细胞占总T细胞的比例明显上升;而CD8+细胞占总T细胞的比例则明显下降。CD4+及CD8+细胞的活化率均明显下降。两两对比差异有显著性,P均<0.05。②Spearman等级相关分析表明,OSAHS的严重程度与CD4+细胞百分比呈负相关,与CD8+细胞、活化的CD4+及CD8+细胞百分比呈正相关(rs分别为-0.5432、0.5166、0.4315、0.4761)。结论OSAHS患者可能存在细胞免疫功能的下降,T细胞包括CD4+细胞及CD8+细胞有异常活化,且病情加重以上变化更明显,nCPAP可逆转这种改变。

Objective To investigate the change of the activated CD4^±and CD8^＋ cells in patients with obstructive sleep apnea hypopnea syndrome（OSAHS）. Methods 116 subjects were classed into normal. mild,moderate.severe groups according to Polysomnography（ PSG）. Each group included 29 patients. The percentage of the CD4^＋ and CD8^＋ cells of the peripheral blood in the total T cells and the percentage of the activated CD4^＋ and CD8^＋ cells in the total CD4^＋ and CD8^＋ cells in each group were measured by flow cytometry. Meanwhile,16 patients of the severe group were treated with nCPAP for one month. Results The percentage of the CD4^＋ cells in the total T cells were 71.0%±8.0%.65.0%±4.5%,54.2%±6.8%. 43.0%±4.7% and the CD8%± cells were 24.4%±8.7%.30.3%±5.0%, 10. 1%±7.0%.49.4%±6.7% in the subjects of the normal, mild, moderate, severe groups, respectively, The percentage of the activated CD4^＋ cells were 1.4%±0.5%,5.0%±0.6%.8. 1%±0.5%,9.7% %0.7%,and the CD8^＋ cells were 7.50%±0.7%.8.2% ± 0.5 %. 12.0%± 1. 1 % , 13.3% ± 1. 1 % respectively. The percentage of the CD4^＋ and CD8 ^＋cells in the total T cells and the percentage of the activated CD4^＋ and CD8^＋ cells among each group were different significantly （ P 〈0.001 ）. The percentage of the CD4^＋ cells after treatment significantly increased while the percentage of the CD8^＋ cells and the percentage of the activated CD4^＋ and CD8^＋ cells significantly decreased （ P〈0.05）. The percentage of the CD4^＋ cells was negatively correlated. but the percentage of the CD8^＋ cells, activated CD4^＋ and CD8^＋ ceils was positively correlated with the severity of the OSAHS （ r =-0.5432.0.5166,0.4315.0.4761）.Conclusions OSAHS may influence the immune system. T cells including the CD4^＋and CD8^＋ cells were abnormally activated. The activation is positively correlated with the severity of the OSAHS.which can be ameliorated by nCPAP.