经鼻持续气道内正压通气治疗对重叠综合征患者血管内皮功能的影响

Effect of nasal continuous positive airway pressure treatment on vascular endothelial function of patients with overlap syndrome

目的探讨经鼻持续气道内正压通气(nCPAP)治疗对重叠综合征血管内皮功能的影响及其临床意义。方法测定36例重叠综合征nCPAP治疗前、后外周血内皮素1(ET-1)、一氧化氮(NO)水平,计算NO/ET-1比值,进行24小时血压监测,多导睡眠图监测(PSG)监测,记录24小时平均收缩压(24 hMSBP)、24小时平均舒张压(24 hMDBP)、24小时平均心率(24 hMHR)、白昼(day,d)d MSBP、d MDBP、d MHR、夜间(night,n)(nMSBP)、nMDBP、nMHR及睡眠呼吸紊乱指数(AHI)、最长呼吸暂停时间(L apnea)、最低血氧饱和度(L SaO2)、血氧饱和度(SaO2)<90%时间。结果重叠综合征患者接受nCPAP治疗后血浆ET-1水平较治疗前明显下降;NO水平及NO/ET-1较治疗前明显上升;24小时动态血压整体水平、白昼水平、夜间水平及AHI、Lapnea、SaO2<90%时间较治疗前明显下降;血压昼夜节律改善;L SaO2较治疗前上升。结论重叠综合征存在严重的血管内皮功能失调;nCPAP治疗能明显改善与呼吸暂停有关的低氧,调节血管内皮功能,减少ET-1的分泌,改善血管舒缩功能失调。

Objective To explore the effect and clinical significance of nasal continuous positive airway pressure （nCPAP） treatment on vascular endothelial function in patients with overlap syndrome. Methods Thirty-six eases of Overlap syndrome were recruited. Plasma endothelin-1（ET-1） and nitric oxide（NO）, polysomnography and ambulatory blood pressure,including 24 hour mean systolic blood pressure （24 hMSBP）,24 hour mean diastolic blood pressure（24 hMDBP） ,24 hour mean heart rate（24 hMHR）, day mean systolic blood pressure（dMSBP）, day mean diastolic blood pressure （dMDBP）, day mean heart rate（dMHR）, night mean systolic blood pressure（nMSBP）, night mean diastolic blood pressure（nMDBP）, night mean heart rate （nMHR）, apnea hypopnea index （ AHI）, the longest time of apnea （L apnea）, the lowest oxygen saturation （L SaOz ）, and the accumulated time when SaO2 than 90 % （SaO2〈 90 %） were examined before and after nCPAP treatment. Results Compared with the parameters before treatment, there were significant decrease in plasma ET-1,24 hMSBP, 24 hMDBP, 24 hMHR, dMSBP, dMDBP, dMHR, nMSBP, nMDBP, nMHR,AHI, L apnea and the accumulated time of SaO2〈90 %, but there were increase in plasma NO and NO/ET-1. Conclusion There is severe disorder of vascular endothelial function in overlap syndrome; nCPAP treatment can improve hypoxia, regulate vascular endothelial function,decrease ET-1 secretion,improve disorder of vasomotoricity.