持续气道正压通气治疗对OSAHS患者呼出气冷凝液和血清中瘦素水平的影响

Effects of continuous posittive airway pressure therapy on the concentrations of leptin in exhaled breathcondensate and blood of patients with obstructive sleep apnea-hypopnea syndrome

目的探讨自动调节持续气道正压通气（auto-CPAP）治疗对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者呼出气冷凝液（EBC）和血清中瘦素水平的影响。方法根据多导睡眠监测确诊的42例中重度OSAHS患者，随机分为治疗组22例和对照组20例，对治疗组进行三个月auto-CPAP治疗，对治疗组和对照组患者均采取常规治疗，分别测定治疗组及对照组三个月前后EBC和血清中的瘦素。结果①治疗组患者EBC和血清中瘦素治疗前[（5．67±1．07）μg／L、（40．20±5．40）μg／L]高于治疗后[（3.75±1．09）μg／L、（30．46±5．82）μg／L]（P〈0．01）；②对照组患者EBC和血清中Lep治疗前为[（5．52±1．14）μg／L、（42．19±4．96）μg／L]，治疗后为[（5．95±1．26）μg／L、（42．69±4．33）μg／L]，治疗前后差异无统计学意义（P〉0．05）；③OSAHS患者EBC和血清中瘦素水平与呼吸暂停低通气指数呈正相关（r=0．787，P〈0．01；r=0．775，P〈0．01），与最低血氧饱和度、平均血氧饱和度呈负相关（r=-0．829，P〈0．01；r=0．794，P〈0．01）、（r=-0．890，P〈0．01；r=-0．830，P〈0．01）。结论OSAHS患者存在高瘦素血症，auto-CPAP治疗可以改善OSAHS患者的高瘦素血症。

Objective To investigate the effect of auto-CPAP therapy on the concentrations of leptin in exhaled breath condensate and plasma in patients with obstructive sleep apnea-hypopnea syndrome （ OSAHS ）. Methods 42 patients with moderate-to-severe OSAHS diagnosed by polysomnograpgy monitoring were randomly allocated to the active group （ n =22） or the control group （ n= 20） respectively. The active group received the treatment of three months＇ auto-CPAP and all of the subjects received general treatment. Leptin levels in EBC and plasma were measured by enzyme linked immunosorbent assay （ELISA） before and after 3 months. Results ①The concentrations of leptin in EBC and plasma in the active group before treatment [（5.67±1.07）μg/L, （40.20±5.40） μg/L] were higher than the after [（3.75±1.09） μg/L, （30.4,6±5.82） μg/L]. ②The concentrations of leptin in EBC and plasma in the control group before treatment were[（5.52±1.14）μg/L,（42.19±4. 96）μg/L] and were [（5.95±1.26） μg/L,（42.69±4.33）μg/L] after the treatment. But there was no statistical difference tetween the befqre and after the treatment. ③Leptin levels in plasma and EBC were positively related with apnea hypoventilation index（AHI）, and were inversely related with the lowest blood oxygen saturation （ r =-0. 829, P 〈0.01, r =0. 794, P 〈0.01）and average blood oxygen saturation （ r = -0. 890, P 〈0.01. r = -0. 830, P 〈0 01）. Conclusions The hyperleptinemia in OSAHS patients and can be improved by auto-CPAP treatment.