阻塞性睡眠呼吸暂停低通气综合征患者血浆血管内皮生长因子、一氧化氮的变化及意义

Changes of plasma vascular endothelial growth factor and plasma nitric oxide in patients with obstructive sleep apnea-hypopnea syndrome

目的初步探讨血管内皮生长因子（vascular endothelial growth factor，VEGF）及一氧化氮（nitric oxide，NO）在阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea—hypopnea syndrome，OSAHS）病理生理过程中的意义。方法①20例单纯OSAHS患者、26例OSAHS合并心脑血管病患者和20例正常人，经多导睡眠仪监测后，检测血浆VEGF和NO浓度。②将OSAHS合并心脑血管病患者分成两组，一组给予经鼻持续正压通气（nCPAP）治疗6个月，共15例设为nCPAP治疗组；其余11例不给予任何针对OSAHS的治疗，设为对照组；观察治疗前后的血浆VEGF和NO浓度。结果①三组血浆VEGF浓度从高到低分别为：OSAHS合并心脑血管病患者（194．9±67．9）pg／ml、单纯OSAHS患者（140．6±47．8）pg／ml、正常对照组（115．0±54．1）pg／ml，差异有统计学意义；②三组血浆NO浓度从低到高分别为：OSAHS合并心脑血管病患者（58．7±17．7）μmol／L、单纯OSAHS患者（76．0±23．7）μmol／L、正常对照组（86．3±45．0）μmol／L，差异有统计学意义；③接受nCPAP治疗的OSAHS合并心脑血管病患者6个月后血浆VEGF浓度较治疗前下降[（217．6±53．2）pg／ml vs（136．2±29．9）pg／ml，P〈o．013，血浆NO浓度较治疗前升高[（56．0士16.8）／2mol／L协（80．3±16．7）μmol／L，P〈0．01]。结论①OSAHS患者血浆VEGF浓度升高，血浆NO水平下降；②合并心脑血管病的OSAHS患者比无心脑血管并发症的单纯OSAHS患者血浆VEGF浓度升高更显著，血浆NO水平下降更明显；③经nCPAP治疗后，OSAHS合并心脑血管病患者血浆VEGF浓度下降，血浆NO水平增加。

Objective To investigate the changes of vascular endothelial growth factor（VEGF） and nitric oxide （NO） in obstructive sleep apnea-hypopnea syndrome （OSAHS）. Methods All the subjects underwent overnight polysomnography. In Experiment 1 ,plasma concentrations of VEGF were measured by a quantitative enzyme-linked immunoassay technique and plasma levels of NO were measured as plasma nitrites and nitrates in group 10SAHS patients with cardiovascular or cerebrovascular diseases （ n = 26）; group 20SAHS patients without cardiovascular or cerehrovascular diseases （ n = 20） ; group 3 healthy adults（ n = 20）. In Experiment 2, OSAHS patients with cardiovascular or cerebrovascular diseases were divided into two subgroups, which were classified：＂nCPAP acceptors＂ including the patients who accepted nasal continuous positive airway pressure treatment （nCPAP）（ n = 15） and ＂controls＂including patients who did not accept any treatment for OSAHS（n= 11）. VEGF and NO concentrations were compared in each subgroup before and half-year after treatment with nCPAP. Results Experiment 1 ：（1） VEGF concentrations were found to be significantly higher in OSAHS patients compared with healthy adults, with （194.9 ± 67.9） ingroup 1 , （ 140.6 ± 47.8 ） in group 2 and （ 115.0 ± 54.1 ） pg / mlingroup 3 , respectively （ P 〈 0.01 ）.（2） Plasma NO levels were lower in OSAHS patients than healthy adults,with （58.7± 17.7） in group 1, （76.0±23.7） in group 2 and （86.3±45.0） μmol/L in group 3, respectively（ P 〈0.05）. Moreover,OSAHS with cardiovascular or cerebrovascular diseases had higher VEGF levels and lower NO levels than those without cardiovascular or cerebrovascular diseases. Experiment 2： A significant decrease in VEGF concentrations and a significant increase in NO levels were found in＂nCPAP acceptors＂after treatment [（217.6±53.2） pg/ml vs （136.2±29.9） pg/ml, P 〈0.01];[（56.0±16.8） μmol/L vs （80.3±16.7） μmol/L, P 〈0.01]. There was no significant change in both VEGF and NO in the patients who did not accept any treatment for OSAHS. Conclusions OThe patients with OSAHS had higher plasma VEGF levels and lower plasma NO levels than healthy adults. QOSAHS with cardiovascular or cerebrovascular diseases had higher VEGF levels and lower NO levels than those without cardiovascular or cerebrovascular diseases. （3）There were a decrease in VEGF concentrations and an increase in NO levels in OSAHS with cardiovascular or cerebrovascular diseases after nCPAP treatment.