稳定气道正压治疗冠心病合并阻塞性睡眠呼吸暂停综合征病人的黏附分子变化

Constant positive airway pressure treated coronary heart disease with obstructive sleep apnea syndrome and changed levels of intercellular adhesion molecules

目的从反映血管内皮炎症的黏附分子角度探讨阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)是否促进和加重冠心病发生发展及其可能机制。比较该类冠心病合并OSAS病人经过稳定气道正压(constant positive airway pressure,CPAP)治疗后低氧血症和夜间反复低氧发作的改善是否能降低黏附分子的含量。方法冠心病组56例、冠心病合并OSAS组58例、OSAS组54例和健康组53例。以酶联免疫吸附试验检测血清中的细胞间黏附分子(intercellular adhesion molecule,ICAM-1)及血小板-内皮细胞黏附分子(platelet endothelial cell adhesion molecule 1,PECAM-1)浓度。然后在冠心病合并OSAS组及OSAS组中各选取5例病人,以Autoset spirit CPAP呼吸机对病人行1周治疗,再次检测血清中黏附分子含量。并比较睡眠呼吸指标改善情况。结果①组间黏附分子含量:冠心病合并OSAS组的黏附分子含量明显高于与其他各组(P<0.01)。冠心病组与OSAS组的黏附分子含量比较,组间差异无统计学意义(P>0.05)。健康组的黏附分子含量最低,明显低于其他3组(P<0.01);②黏附分子与多导睡眠图监测:两种黏附分子含量与呼吸紊乱指数(apnea hyponea index,AHI)呈正相关,与夜间平均血氧饱和度呈负相关,与最低血氧饱和度不相关;③冠心病合并OSAS病人的ICAM-1含量,CPAP治疗前为(434±115)μg/L,治疗后为(304±105)μg/L(P<0.05);治疗后冠心病合并OSAS病人的PECAM-1含量也明显降低;同时单纯OSAS组病人的ICAM-1和PECAM-1含量经过CPAP治疗后也有明显降低;④CPAP治疗前后冠心病合并OSAS组及OSAS组病人AHI、夜间平均血氧饱和度等指标均有改善。结论OSAS病人黏附分子增高,冠心病合并OSAS后黏附分子更高,CPAP能降低黏附分子含量,故黏附分子升高可能与间断的呼吸暂停所致的夜间反复低氧发作及血氧饱和度持续减低有关,从而加重了冠心病的血管内皮炎症。提示CPAP治疗OSAS的冠心病病人的重要性,其不失为该类冠心病病人二级预防的一种手段。

Objectives To observe changes in the serum level of intercellular adhesion molecule （ICAM-1） and platelet endothelial cell adhesion molecule 1 （PECAM-1） in the 4 groups and to investigate whether the hypoxia can aggravate the endothelial inflammatory response and to study the influence of the constant positive airway pressure （CPAP） on the serum levels of the cell adhesion molecules （CAMs） in the coronary heart disease （CHD） patients with obstructive sleep apnea syndrome （OSAS）. Methods The patients were divided into four groups ： CHD group, CHD complicated with OSAS group, OSAS group and control group. The ICAM- 1 and PECAM-1 were examined by ELISA. Auto-set spirit CPAP was used to treat the patients with apnea hyponea index （AHI） more than 20. Results ① The serum level of the ICAM-1 and PECAM-1 in the CHD with OSAS group was the highest among the four groups （P〈0.05）. There was no difference between the CHD group and the OSAS group （P ：〉0.05）. The control group was the lowest among the four groups （P〈0.05）. ② The serum levels of the CAMs had the positive correlation with the AHI （r=0.324, P〈0.05）, and had the negative correlation with the lowest saturation of oxygen （r=-0.339, P〈0.01）. ③ Through the CPAP therapy, the serum ICAM-1 level of the CHD with OSAS group was decreased from （434±115） p,g/L to （304±105） μg/L （P〈0.05）. ④ AHI of the patients with OSAS was decreased significantly after treating CPAP （P〈0.05）. Meanwhile, the level of the average oxygen saturation was significantly increased （87.2±2.1）% to （94.2±2.5）%（P〈0.05）. Conclusions The patients with OSAS show a high level of ICAM-1 and PECAM-1, which aggravate the vascular endothelial inflammation. The adhesion molecules levels are increased after the course of the apnea and hypoxia through the night. CPAP can ameliorate the sleep apnea, improve oxygen saturation, and decrease the CAMs serum level in CHD with OSAS patients. So the serum levels of the CAMs are associated with the seriousness of the OSAS. CPAP can be applied in the clinical therapy of the CHD patients with OSAS