持续正压通气对阻塞性睡眠呼吸暂停低通气综合征患者心血管危险因素的影响

Influence of continuous positive airway pressure treatment on cardiovascular risk factors in patients with ob- structive sleep apnea-hypopnea syndrome.

目的探讨经鼻持续正压通气（nCPAP）对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者心血管疾病危险因素的影响。方法将最新在呼吸睡眠监测中心确诊的中重度OSAHS患者31例，依据其使用呼吸机nCPAP时间的长短将其分为3组：组1（10例），〉4h／晚；组2（9例），〈4h／晚；组3（12例），拒绝使用呼吸机。分别在基础水平和6月后进行多导睡眠分析（PSG），全自动生化仪检测血清胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL—C）、低密度脂蛋白胆固醇（LDL-C）、载脂蛋白A-I、载脂蛋白B，ELISA法检测外周血C-反应蛋白。结果①3组患者年龄、体重指数、血压、ESS评分以及血氧饱和度等比较差异均无统计学意义（P均〉0．05）；②组1、组2经过nCPAP治疗的OSAHS患者，其ESS评分、SP02、最低SPO2较治疗前基线水平明显改善[（3．24±2．81）分与（13．3±5．2）分、（4．95±2．67）分与（12．8±5．5）分；（93．8±2．01）％与（88．6±4．14）％、（94．2±1．46）％与（89．1±5．11）％；（84．1±6．17）％与（69．6±11．77）％、（85．2±4．97）％与（73．7±12．5）％；P均〈0．01]；③组1经过nCPAP治疗后总胆固醇水平较前明显下降，差异有统计学意义（P=0．038）；④经过nCPAP治疗后，组1、组2血清CRP水平较前均有下降，且组1治疗前后比较差异有统计学意义（P=0．021）。结论依从性好的OSAHS患者经过nCPAP治疗后，能够显著降低心血管危险因素，这将为临床上心血管疾病危险因素的治疗提供新策略。

Objective To investigate the influence of nasal continuous positive airway pressure （nCPAP） treatment on cardiovascular risk factors in patients with obstructive sleep apnea-hypopnea Syndrome （OSAHS）. Methods Thirty-one patients with newly diagnosed OSAHS were divided into 3 groups based on the status of nC-PAP treatment： group 1,10 patients with nCPAP 〉4 hrs/night;group 2：9 patients with nCPAP 〈4 hrs/night; group 3：12 patients without nCPAP treatment. Serum cardiovascular risk factors （i. e. , C-reactive protein（CRP） , total cholesterol, triglycerides, highdensity lipoprotein cholesterol （ HDL-C ）, low-density lipoprotein cholesterol, apolipoprotein A-I （ApoA-I）,and apolipoprotein B （ApoB）） were measured at baseline and 6 months after nCPAP treatment. Results ①There was no significant difference on age, body mass index, blood pressure, Epworth sleepiness scale （ESS） and saturation of blood oxygen （ SPOz ） between the 3 groups （ P 〉 0.05 ）. ②In group 1, ESS, SPO2 minimum SPO2 were significantly improved （ 3.20±2.80,93.80±2.01 and 84.10±6.17, respectively） compared to baseline （13.30±5.20,88.60±4.14 and 69.60±11.80, respectively） （P 〈 0.01 ）. Moreover, in group 2, there were significant improvement on ESS, SPO2 and minimum SPO2 （4.95±2.67,94.20±1.46 and 85.20±4.97, respectively） compared to baseline （ 12.80±5.50,89.10±5.11 and 73.70±12.50, respectively） （ P 〈 0.01 ）. ③In group 1, significant decreases in the levels of C RP, total cholesterol was observed （ P = 0. 021 and 0.038 ）. ④In group 2, group 3 there were slightly decrease of CRP after treatment, but the difference did not reach statistical significance. Conclusions Good compliance to nCPAP treatment decreases the serum levels of cardiovascular risk factors,indicating a beneficial effect on the overall cardiovascular disease prevention and control.