经鼻持续气道正压通气对糖尿病肾病伴阻塞性睡眠呼吸暂停患者VEGF及ICAM-1的影响

Effects of Nasal Continuous Positive Airway Pressure on VEGF and ICAM-1 of Diabetic Nephropathy Complicated with Obstructive Sleep Apnea Syndrome

目的:探讨经鼻持续气道正压通气(nasal continuous positive air pressure,nCPAP)治疗对糖尿病肾病(diabeticnephropathy,DN)伴阻塞性睡眠呼吸暂停综合征(obstructive sleep apnoea syndrome,OSAS)患者VEGF及ICAM-1的影响。方法:选择临床确诊的DN伴中度鼾症患者36例,年龄35岁～62岁。随机分为治疗组及对照组,对照组给予常规治疗血糖、血压以及血脂等药物,治疗组系在对照组基础上,同时给予nCPAP治疗3个月,检测指标:(1)血压、血糖、糖化血红蛋白、肾功能、血脂及24h尿蛋白定量等。(2)采用定量酶联免疫吸附试验(ELISA)检测血清VEGF、ICAM-1水平。(3)常规检测血氧饱和度(SaO2)及呼吸暂停低通气指数(apnea-hypopnea index,AHI)。结果:经过3月的nCPAP治疗,两组治疗后患者血压、血肌酐、空腹血糖、糖化血红蛋白以及血脂水平差异无统计学意义(所有P>0.05),两组患者治疗前血氧饱和度、以及AHI未见明显差异;经nCPAP治疗后治疗组比对照组AHI显著下降(P<0.05),夜间MSaO2以及LSaO2大幅提高(P<0.05),治疗后两组血清VEGF、ICAM-1以及24h尿蛋白均有减少,治疗组与对照组相比差异有统计学意义(P<0.05)。结论:在常规疗法基础上,nCPAP治疗可能通过调节OSAS合并DN患者VEGF以及ICAM-1表达水平,从而达到减少尿蛋白,减轻肾脏损伤的目的。

Objective：To investigate the effects of nasal continuous positive airway pressure（nCPAP） on VEGF and ICAM-1 of diabetic nephropathy（DN） complicated with obstructive sleep apnea syndrome（OSAS） patients.Methods：35~62 years old subjects who presented as DN complicated with moderate to severe OSAS were recruited and divided into nCPAP treated group and control group.The plasma levels of blood glucose,cholesterol,glycosylated hemoglobin,creatinine and urinary protein excretion were measured by auto biochemistry analysis machine.The plasma levels of VEGF（vascular endothelial growth factor） and ICAM-1（intercellular Adhesion Molecule-1） were determined by ELISA.Results：After 3 months of nCPAP treatment,there was a significant decrease in circulating levels of VEGF and ICAM-1 as well as 24 hours urinary protein excretion in nCPAP treated group.Decreased urinary protein excretion rate presented a positive relationship to reduced plasma VEGF and ICAM-1 levels separately.Conclusion：nCPAP treatment could reduce urinary protein excretion by decreasing plasma levels of VEGF and ICAM-1 in DN complicated with OSAS patients.