阻塞性睡眠呼吸暂停低通气综合征并肺动脉高压者血浆内源性CO、肾上腺髓质素水平

The plasma levels of endogenous carbon monoxide and adrenomedullin in patients with obstructive sleep apnea-hypopnea syndrome complicating pulmonary hypertension

目的测定阻塞性睡眠呼吸暂停低通气综合征(OSAHS)并肺动脉高压(pH)患者血浆一氧化碳(CO)、肾上腺髓质素(adrenomedullin,ADM)水平,分析其在pH发生发展中的作用。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CO、ADM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组血浆内源性CO、ADM水平[CO:(1.04±0.16)mg/L,ADM:ADM:(54.19±11.60)pg/ml;CO:(1.35±0.13)mg/L,ADM:ADM:(79.82±15.33)pg/ml]均高于正常对照组[CO:(0.51±0.16)mg/L,ADM:(44.73±8.52)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CO、ADM水平明显降低[CO:(1.35±0.13)mg/L,ADM:(79.82±15.33)pg/ml;CO:(1.16±0.11)mg/L,ADM:(63.48±10.76)pg/mlP<0.01],血浆CO、ADM水平与RVPEP/AT、AHI、TSaO2呈正相关,与minSaO2呈负相关。结论CO、ADM共同参与了OSAHS患者pH的发生发展过程。

Objective To study the plasma levels of endogenous carbon monoxide （CO） and adrenomedullin（ADM） in patients with obstructive sleep apnea-hypopnea syndrome （OSAHS） complicating pulmonary hypertension（pH） and their significance in the development of pH. Methods 48 patients with OSAHS were divided into pure OSAHS group and OSAHS complicating pH group. 30 healthy subjects served as a normal control group. The plasma CO and ADM levels, RVPEP/AT,AHI, minSaO2 and TSaO2 were measured and the correlation analysed. Results The plasma CO and ADM levels in pure OSAHS group [ CO- （ 1.04 ± 0. 16） mg/ L, ADM ： （ 54. 19 ± 11.60 ） pg/ml ] and OSAHS complicating pH group [ CO ： （ 1.35 ± 0. 13 ） mg/L, ADM ： （79. 82 ± 15.33 ） pg/ml ] were both significantly higher than those in controls [ CO ： （0. 51 ± 0. 16） mg/L, ADM ： （44. 73 ± 8.52 ） pg/ml ] （ P 〈 0.01 ） and the plasma CO and ADM levels in OSAHS complicating pH group were higher than those in pure OSAHS group（P 〈0.01 ）. The plasma CO and ADM levels in patients with OSAHS complicating pH[ CO ： （ 1.35 ± 0. 13 ） mg/L, ADM ： （ 79. 82 ± 15.33 ） pg/ml ; CO ： （ 1.16 ± 0. 11 ） mg/L, ADM ： （ 63.48 ± 10. 76） pg/ml, P 〈 0.01 ] were significantly decreased after nCPAP application. Moreover, the plasma CO and ADM levels were positively correlated with RVPEP/AT, AHI,TSaO2 and negatively correlated with minSaO2. Conclusion CO and ADM may take part in the development of pH in patients with OSAHS.