中重度OSAHS患者血清PTX3、HIF-1α水平变化及CPAP干预作用

Study of the levels of the plasma PTX3, HIF-1α and the effect of CPAP treatment in moderate to severe OSAHS patients

目的通过观察中重度OSAHS患者血清中PTX3、HIF-1α的水平变化及与PSG参数的相关性分析,及其在CPAP治疗后对PTX-3、HIF-1α血清浓度的影响,探讨OSAHS患者血浆PTX3、HIF-1α的水平变化及可能机制。方法正常对照组(25例)、中重度OSAHS(50例)、中重度OSAHS行CPAP治疗组(10例)治疗前后均行多导睡眠图(PSG)监测,次日晨起睡眠监测结束后采集静脉血。以ELISA法分别测定所采集血清中PTX3、HIF-1α浓度。结果中重度OSAHS患者血清PTX3与HIF-1α含量较对照组升高(P<0.05),PTX3、HIF-1α水平呈正相关(r=0.281,P<0.05),中重度OSAHS患者血清PTX3、HIF-1α水平与呼吸暂停低通气指数(AHI)正相关(r分别为0.311,0.485,P<0.05)、与血氧饱和度低于90%时间占总睡眠时间百分比正相关(r分别为0.349,0.444,P<0.05),与最低血氧水平负相关(r分别为-0.327,-0.535,P<0.05)。PTX3的多元逐步回归分析,发现PTX3的影响因子是T-SO2<90%(0.953)。经CPAP治疗,中重度OSAHS患者血清PTX3、HIF-1α水平与治疗前比较明显降低(P<0.05)。结论血清PTX3、HIF-1α水平在中重度OSAHS患者中明显升高,与中重度OSAHS患者的AHI及低氧程度正相关,且通过CPAP治疗后其水平明显降低。提示中重度OSAHS患者血清PTX-3、HIF-1α水平升高可能与慢性间断性低氧有关,纠正慢性间断性低氧能降低其水平。

[ Objective ] To investigate the effect of frequency of intermittent hypoxia of obstructive sleep apnea- hypopnea syndrome（OSAHS） on the levels of the plasma pentraxin 3 （PTX3） and hypoxia-indueible factor-1a （HIF- 1a）. To provide the mechanism and the effect of CIH on levels of plasma pentraxin 3 （PTX3） and hypoxia-inducible factor-1a（HIF-1a） in OSAHS. [Methods] All cases are collected by monitoring of polysomnography （PSG）. There are three groups： （1） group A ：healthy control, 25 cases; （2） group B： patients with moderate to severe OSAHS, 50 cases; （3） group C： Moderate to severe OSAHS patients treated with continuous positive airway pressure （CPAP） for 1 month, 10 cases. In the morning of finishing PSG, blood specimens were collected in all groups, then ELISA was used to examine the levels of PTX3 and HIF-1a in serum. [Results] Plasma PTX3 levels and HIF-1a in the mod- erate-to-severe OSAHS group were significantly higher than those in control group （P 〈0.05）. There was a positive correlation between PTX3 levels and HIF-1a levels in the moderate to severe OSAHS group （r=0.281, P 〈0.05）.Both Plasma PTX3 and HIF-1a levels positively related to AHI and T-SaO2 〈 90%, while negatively related to the lowest oxygen saturation. Stepwise multiple regression analysis revealed that Plasma PTX3 level was influenced by the factors of T-SO2 〈90% （0.953）. Plasma PTX3 and HIF-1a levels were significantly reduced （P 〈0.05） in the moderate to severe OSAHS patients after 1 month of CPAP therapy. [Conclusions] Plasma PTX3 and HIF-1a levels were significantly elevated in patients with moderate to severe OSAHS, and showed positive correlation with AHI and the degree of hypoxia. Plasma PTX3 and HIF-1a levels were signifieantlyreduced in moderate to severe OSAHS patients after 1 month of CPAP therapy. This suggests that the changes of plasma PTX3 and HIF-1a levels possibly are associated with CIH and plasma PTX3 and HIF-1a levels in OSAHS can be managed by CPAP.