阻塞性睡眠呼吸暂停低通气综合征患者体内氧化应激与血管内皮细胞凋亡相关性研究

Relationship between oxidative stress and endothelial cell apoptosis in patients with obstructive sleep apnea-hypoventilation syndrome

目的探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者体内氧化应激与内皮细胞凋亡相关性。方法经多导睡眠图监测确诊为OSAHS的患者67例，根据呼吸暂停低通气指数（AHI）分为轻度组（5〈AHI≤20）14例，中度组（20〈AHI≤40）21例，重度组（AHI〉40）32例。正常对照组（AHI〈5）18例。各组均于多导睡眠图监测后采空腹静脉血，检测内皮细胞凋亡水平、血清超氧化物歧化酶及丙二醛。结果与对照组比较，中、重度OSAHS组血清丙二醛及内皮细胞凋亡水平增高，血清超氧化物歧化酶水平降低，差异有统计学意义（均P〈0．05）。OSAHS患者内皮细胞凋亡水平与AHI、最长呼吸暂停时间、氧减指数呈显著正相关（r值分别0．778、0．609、0．689，均P〈0．05），与夜间最低动脉血氧饱和度呈显著负相关（r=一0．635，P〈0．01）；与血清丙二醛呈显著正相关（r=0．698，P〈0．01），与血清超氧化物歧化酶呈显著负相关（r=-0．705，P〈0．01）。多元逐步回归分析显示，AHI、血清超氧化物歧化酶及丙二醛水平是影响OSAHS患者内皮细胞凋亡水平的独立危险因素。结论OSAHS患者体内存在氧化应激反应，间断缺氧所致的氧化应激增强是加重血管内皮损伤的主要原因。

Objective To study the relationship between oxidative stress and endothelial cell apoptosis in patients with obstructive sleep apnea-hypoventilation syndrome （ OSAHS ）. Methods Sixthseven patients definitely diagnosed by polysomnography （PSG） as OSAHS were divided into three groups according to their apnea-hypoventilation index （AHI）, 14 in mild group （5 〈 AHI≤20） , 21 in moderate group （20 〈 AHI≤40） and 32 in severe group （AHI 〉40）. And, 18 healthy persons （AHI 〈5） were recruited as controls. Blood samples were obtained form all of them after PSG performance for measuring apoptotic endothelial cells （CD146^Annv＋） and serum levels of superoxide dismutase （SOD） and malondialdehyde （MDA）. Results Serum level of MDA and CD146^Annv＋ in moderate and severe OSAHS group were significantly higher than those in control group （ all P 〈 0. 05 ）. Serum level of SOD in moderate and severe OSAHS group was significantly lower than that in control group （ P 〈 0. 05 ） . CD146^Annv＋ correlated positively with AHI, the longest apnea time （LAT） and oxygen desaturation index （ODI） （r = 0. 778, 0. 609 and 0. 689, respectively, all P 〈 0. 05 ） and correlated reversely with saturation of arterial blood oxygen at night （SaO2min） （r = - 0. 635, P 〈 0. 01 ）. CD146A＂nv＋ correlated positively with serum level of MDA （ r = 0. 698, P 〈 0. 01 ） , and correlated reversely with serum level of SOD （ r = - 0. 705, P 〈 0. 01 ）. Results of linear multivariate regression analysis showed that AHI, serum levels of SOD and MDA were independent risk factors for endothelial cells apoptosis in patients with OSAHS. Conclusions There existed oxidative stress due to intermittent hypoxia in patients with OSAHS, which could be one of the major causes in exacerbating endothelial damage.