双水平气道正压通气对重叠综合征患者心功能及血管内皮功能影响

Effect of Bi-level positive airway pressure ventilator on the heart function and vascular endothelial function of patients with the overlap syndrome

目的 探讨双水平气道正压通气（BiPAP）对重叠综合征（OS）患者心功能及血管内皮功能的作用机制.方法 对2009年1月至2010年9月南京医科大学附属江宁医院呼吸科睡眠监测室进行多导睡眠监测（PSG）的人群进行筛选,共入选患者120例,其中男87例,女33例,年龄40～53岁,平均（48±4）岁;根据肺功能及PSG检查结果分为：对照组、OSAHS组、COPD组和OS组.所有人群均测定肺功能指标：FEV1占预计值%、FEV1/FVC和峰值呼气流速（PEF%）;心功能指标和血管内皮功能指标：内皮素-1、一氧化氮和凝血酶-Ⅲ;PSG指标：AHI、LSaO2及SaO2＜90%时间.OS组患者经BiPAP治疗并随访一个月,记录治疗前后的各项指标并比较.组间比较采用单因素方差分析,组间两两比较采用LSD法,治疗前后比较采用配对t检验.结果 OS组患者FEV1占预计值%为（48±7）%、FEV1/FVC为（46±6）%和PEF%为（47.5±5.3）%均明显低于其他3组（F值为215.47～681.65,均P＜0.05）,血管内皮功能明显受损,内皮素-1含量为（48±10）ng/L（F值为46.61～259.12,均P＜0.05）;经BiPAP治疗后,OS患者心肺功能及血管内皮功能得到明显改善,FEV1占预计值%、FEV1/FVC及PEF%分别为（58±7）%、（56±7）%及（57.5±2.5）%,内皮素-1含量降至（38±8）ng/L（t值为-17.13～42.06,均P＜0.05）.结论 OS可引起明显的低氧血症,从而促使血管内皮功能严重受损.BiPAP治疗能明显改善与呼吸暂停有关的低氧,从而调节血管内皮的功能,可能会成为预防OS合并心血管疾病的重要途径.

Objective To study the mechanism of Bi-level positive airway pressure（BIPAP） on the heart function and the vascular endothelial function of the overlap syndrome（OS）. Methods There were 87 males and 33 females （mean age 48 ±4, range 40 -53 years） admitted to the Affliliated Jiangning Hospital respiratory department of Nanjing Medical University. Subjects tested with PSG were allocated to normal,OSAHS, COPD and OS groups by the result of pulmonary function testing. All persons were tested with pulmonary function （FEV1% of predicted, FEV1/FVC% , PEF% ）, heart function （Tei index, BNP）,vascular endothelial function（ET-1, NO, AT-Ⅲ ） and PSG（ AHI, LSaO2, the time of SaO2 ＜90% ）. The measurements were repeated in patients with OS after BiPAP treatment and 1 month after follow-up. One-way ANOVA was used for comparison between 2 groups. Post-hoc multiple comparisons of means were performed by using LSD. Paired-samples t Test was used for comparison of data between baseline and post-treatment.Results The FEV1% of predicted, FEV1/FVC%, and PEF% in the OS group were significantly lower than the those in the other groups （ F = 215.47 - 681.65, P ＜ 0. 05 ）. The vascular endothelial function was impaired more severely than the other groups （ F = 46. 60 - 259. 12, P ＜ 0. 05 ）. The heart function,pulmonary function, and vascular endothelial function were significantly improved after BiPAP treatment（ t =-17. 13- 42.06, P ＜ 0. 05 ）. Conclusion The vascular endothelial dysfunction is associated with OS.Treatment by BiPAP can improve hypoxia and vascular endothelial function, and therefore may be useful in prevention of cardiovascular disease in OS.