阻塞性睡眠呼吸暂停低通气综合征患者血清高敏C反应蛋白检测意义的Meta分析

Significance of High Sensitivity C-reactive Protein in Obstructive Sleep Apnea Hypopnea Syndrome:A Meta-analysis

目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血清高敏C反应蛋白(hs-CRP)检测的意义。方法计算机检索Cochrane Library、PubMed(1979—2011年)、中国学术期刊全文数据库(CNKI,1980—2011年)、维普中文科技期刊数据库(VIP,1989—2011年)、中国生物医学文献光盘数据库(CBMdisc,1980—2011年)和中国重要会议论文全文数据库(1999—2011年),并手工检索相关期刊,全面收集OSAHS患者(病例组)检测hs-CRP的病例对照研究。按照纳入、排除标准筛选文献并评价文献质量,而后提取有效数据进行Meta分析。英文检索词包括:high sensitivity C-reactive protein或hs-CRP、obstructive sleep apnea hypopnea syndrome或OSAHS、obstruc-tive sleep apnea syndrome或OSAS;中文检索词包括:高敏C反应蛋白或超敏C反应蛋白、阻塞性睡眠呼吸暂停低通气综合征或阻塞性睡眠呼吸暂停综合征。结果最终纳入15篇文献,其中外文3篇、中文12篇,包括844例患者。Meta分析结果显示:(1)病例组血清hs-CRP水平显著高于对照组,差异有统计学意义〔SWD=3.73,95%CI(2.76,4.69),P<0.00001〕。(2)OSAHS中重度患者血清hs-CRP水平显著高于轻度OSAHS患者,差异有统计学意义〔SWD=4.04,95%CI(1.14,6.94),P<0.00001〕。(3)比浊法和酶联免疫吸附法(ELISA法)均能有效检测出病例组血清hs-CRP水平显著高于对照组,差异有统计学意义〔SWD=3.27,95%CI(1.75,4.78);SWD=4.02,95%CI(2.28,5.75),P均<0.00001〕。结论现有临床研究证据显示,OSAHS患者血清hs-CRP水平显著增高,检测血清hs-CRP水平在一定程度上能反映OSAHS严重程度;比浊法和ELISA法均能有效检出hs-CRP水平。

[ Abstract ] Objective To investigate the significance of high sensitivity C reactive protein （ hs CRP） in patients with obstructive sleep apnea hypopnea syndrome （OSAHS）. Methods The case control studies involving hs CRP in OSAHS patients （ case group） were searched from Cochrane Library, PubMed, China Academic Journals Full text database, VIP Da tabase, Chinese Biomedical Literature CD ROM databases and full text database of China＇s important meetings, and relevant periodicals were also searched manually. According to inclusion and exclusion criteria the quality of the literatures was evaluated, and then the valid data were extracted for Meta analysis. English search terms included ： high sensitivity C reactive protein or hs CRP, obstructive sleep apnea hypopnea syndrome or OSAHS, obstructive sleep apnea syndrome or OSAS. Chinese search terms included ： high sensitivity C reactive protein or high sensitivity C reactive protein, obstructive sleep apnea hypop nea syndrome or obstructive sleep apnea syndrome. Results 15 literatures and 844 patients were finally included, including 3 English literatures and 12 Chinese literatures. According to Meta analysis： （1） The hs CRP level in case group was signifi cantly higher than in control group [ SWD = 3.73, 95% CI （2.76, 4. 69）, P 〈 0. 000011. （2） The hs CRP level in moder ate to severe OSAHS patients was significantly higher than in mild OSAHS patients [ SWD = 4. 04, 95% CI （1.14, 6. 94 ）, P 〈 0. 00001 ~. （3） Turbidimetric method and the ELISA method can both effectively detect the significantly higher level of hs CRP in case group than in control group [ SWD = 3.27, 95% CI （ 1.75, 4. 78） ; SWD = 4.0：2, 95% CI （2. 28, 5.75）, P all 〈 0. 00001~. Conclusion Existing clinical evidence shows that hs CRP is significantly increased in OSAHS patients.Detecting hs CRP carl to some extent reflect the severity of OSAHS. Turbidimetry and ELISA method can both effectively detect the level of hs CRP.