阻塞性睡眠呼吸暂停低通气综合征伴冠心病：血清高半胱氨酸和C-反应蛋白水平及临床意义

E valuation and clinical significance of serum C-reactive protein and homocysteine level in obs- tructive sleep apnea/hypopnea syndrome complicated with coronary heart disease patients

目的通过对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）合并冠心病患者血清高半胱氨酸（HCY）和c-反应蛋白（CRP）水平的检测分析，探讨HCY、CRP与OSAHS及OSAHS合并冠心病的相关性。方法将研究对象分为正常对照组（30例）、OSAHS组（36例）、OSAHS合并冠心病组（25例），采用化学发光法检测血清HCY和放射免疫法检测血清CRP，并比较3组HCY、CRP的水平；将OSAHS患者按病情再分为轻、中、重度3组，进一步对其冠心病的发生、血清HCY和CRP的水平进行比较；同时比较OSAHS和OSAHS合并冠心病两组患者呼吸暂停低通气指数（AHI）、血氧饱和度（SaO2）等睡眠呼吸监测指标。结果①血清HCY、CRP水平：正常对照组、OSAHS组、OSAHS合并冠心病组3组间有显著差异（F．cv=15．80，FCRP=19．21，P均〈0.01）；0SAHS合并冠心病组显著高于OSAHS组（tRCY=4．74，tCRP=5．14，P均〈0．01）；OSAHS组显著高于正常对照组（tHCY=7．31，tCRP=8．17，P均〈0．01）。②OSAHS病情重度患者冠心病发生显著高于轻、中度组（r=6．96，X^2=4．18，P均〈0．05）；随着OSAHS病情的加重，血清HCY、CRP水平显著上升（FHCY=16．38，FCRP=12．97，P均〈0．01）。⑧单纯OSAHS组及OSAHS合并冠心病组间AHI、SaO2等睡眠呼吸监测指标有显著差异（tAHI=5．46，SaO：〈90％占总睡眠时间的百分比：t=1．88，P均〈0．01；呼吸障碍事件总时间占总睡眠时间的百分比：t=2．47，P〈0．05；最低SaO2：t=4．68，平均最低SaO2：t=3．65，P均〈0．01；呼吸障碍事件最长时间：t=4．73，P〈0．01）。结论OSAHS患者缺氧导致应激引起HCY、CRP水平升高，从而进一步促进冠心病的发生和发展。

Objective To explore the relationship between homocysteine（HCY） and C-reactive protein（CRP） in obstructive sleep apnea/hypopnea syndrome（OSAHS） patients and OSAHS patients compli- cated with coronary heart disease by detecting the scrum level of HCY and CRP on the mechanism of OSAHS complicated with coronary heart disease. Methods Ninety-one patients were divided into three groups, 30 patients as control group, 36 patients as OSAHS group, and 25 patients as OSAHS complicated with CHD group. Serum HCY level was detected through chemiluminescence. Serum CRP level was detected through radioimmunity. The serum level of HCY and CRP was compared among these groups. OSAHS patients were divided into mild OSAHS subgroup, moderate OSAHS subgroup and severe OSAHS subgroup. The morbidity rate of CHD and the serum level of HCY and CRP were compared among these subgroups. Meanwhile the parameters of polysomnogram such as activity apnea-hypopnea index（AHI） and blood oxygen saturation （SaO2） were compared between OSAHS group and OSAHS complicated with coronary heart disease group. Results ① There was significant difference among the serum level of HC Y and CRP of control group, OSAHS group and OSAHS complicated with CHD group （FHCY=15.80, FCRP,=19.21, P all〈0.01）. The serum level of HCY and CRP of OSAHS complicated with CHD group was significantly higher than that of OSAHS group （tHCY=4.74, tCRP=5.14, P all 〈0.01）. The serum level of HCY and CRP of OSAHS group was significantly higher than that of control group （tHCY=7.31, tCRP=8.17, P all 〈0.01）. ② The morbidity rate of CHD of severe OSAHS subgroup was significantly higher than that of mild OSAHS subgroup and that of moderate OSAHS subgroup （X^2=6.96,）（2=4.18, P〈0.05 ）. The serum level of HCY and CRP were correlated with the severity of OSASH （FHCY=1 6.38, FCRp=1 2.97, P all〈0.01 ）. ③There were significant difference between apnea hyponea index and SaO2 of OSAHS group and OSAHS complicated with CHD group （tAHI=5.46, percentage of SaO2 〈 90% in total sleep time： t=1.88, P all〈0.01 ; percentage of disordered breathing event in the total sleep time： t=2.47, P〈0.05 ; lowest SaO2： t=4.68, average lowest SaO2： t=3.65, longest duration of disordered breathing events： t =4.73, P all〈0.01 ）. Conclusion The serum level of HCY and CRP rose because of hypoxia in OSAHS patients, and might play an important role in the mechanism of OSAHS complicated with CHD.