阻塞性睡眠呼吸暂停低通气综合征合并肺动脉高压者血浆肾上腺髓质素、内皮素-1水平及意义

The plasma levels of adrenomedullin and endothelin-1 in patients with obstructive sleep apnea-hypopnea syndrome incorporating pulmonary hypertension and their significance

目的测定阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并肺动脉高压(pH)患者血浆肾上腺髓质素(adrenomedullin,ADM)、内皮素-1(ET-1)水平,并探讨其临床意义。方法选2002年3月至2004年10月在郑州大学第一附属医院经多导睡眠仪监测诊断的58例OSAHS患者,分为单纯OSAHS组、OSAHS并pH组,选取30名健康体检者为正常对照组。检测各组血浆ADM、ET-1水平、RVPEP/AT、AHI、minSaO2及TSaO2水平,并进行相关性分析。结果单纯OSAHS组及OSAHS并pH组血浆ADM、ET-1水平[ADM:(54.19±11.60)pg/ml,ET-1:(52.2±8.96)pg/ml;ADM:(79.82±15.33)pg/ml,ET-1:(79.3±11.25)pg/ml]均高于正常对照组[ADM:(44.73±8.52)pg/ml,ET-1:(37.4±9.85)pg/ml,P<0.01];OSAHS并pH组又高于单纯OSAHS组(P<0.01)。经nCPAP治疗后OSAHS并pH患者血浆ADM、ET-1水平明显降低[ADM:(79.82±15.33)pg/ml,ET-1:(79.3±11.25)pg/ml;ADM:(63.48±10.76)pg/ml,ET-1:(62.4±8.23)pg/ml,P<0.01〗,血浆ADM水平始终与ET-1、RVPEP/AT、AHI、TSaO2呈正相关,与minSaO2呈负相关。结论ADM、ET-1可能参与了OSAHS患者pH的发生发展过程。

Objective To study the plasma levels of adrenomedullin （ADM） and endothelin-1 （ ET-1 ） in patients with obstructive sleep apnea- hypopnea syndrome （OSAHS） incorporating pulmonary hypertension （pH） and their significance in the development of pH. Methods Fifty-eight patients with OSAHS were divid- ed into pure OSAHS group and OSAHS incorporating pH group. Thirty healthy subjects served as a normal control group. The plasma ADM and ET-1 levels, RVPEP/AT, AHI, minSaO2 and TSaO2 were measured and the correlation analysed. Results The plasma ADM and ET-1 levels in pure OSAHS group [ ADM： （54. 19 ± 11.60） pg/ml , ET-1 ： （52.2 ± 8.96） pg/ml ] and OSAHS incorporating pH group [ ADM ： （ 79.82 ±15.33 ） pg/ml, ET-1 ： （79. 3±11.25 ） pg/ml] were both significantly higher than those in controls [ ADM ： （44. 73 ＋ 8. 52） pg/ml, ET-1 ： （37. 4±9. 85） pg/ml] （P 〈0.01 ） and the plasma ADM and ET-1 levels in OSAHS incorporating pH group were higher than those in pure OSAHS group （ P 〈 0. 01 ）. The plasma ADM and ET-1 levels in patients with OSAHS incorporating pH[ ADM： （79.82 ± 15.33 ） pg/ml, ET-1 ： （79. 3 ± 11.25） pg/ ml ; ADM ： （ 63.48± 10. 76） pg/ml, ET-1 ： （62. 4 ＋ 8. 23 ） pg/ml, P 〈 0. 01 ] were significantly decreased after nCPAP treatment. Moreover, the plasma ADM levels were positively correlated with ET-1, RVPEP/AT, AHI,TSaO2 and negatively correlated with minSaO2. Conclusion ADM and ET-1 may take part in the development of pH in patients with OSAHS.