血清半胱氨酸白三烯对儿童阻塞性睡眠呼吸暂停低通气综合征的诊断价值

Diagnostic value of serum cysteine leukotriene levels for obstructive sleep apnea hypopnea syndrome in children

目的探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患儿血清半胱氨酸白三烯（CysLTs）水平的变化及临床意义。方法选择因疑似打鼾而就诊于新疆医科大学第一附属医院门诊及住院的患儿进行研究，以多导睡眠仪（PSG）监测结果作为金标准，将患儿分为OSAHS组41例，对照组34例；OSAHS组中汉族25例，维吾尔族12例，其他民族4例；按呼吸暂停指数（AHI）将OSAHS组分为轻、中、重3组，采用竞争ELISA法测定患儿血清CysLTs水平。将OSAHS组的血清CysLTs水平与各睡眠呼吸参数进行相关性分析，评价血清CysLTs水平对OSAHS患儿的早期诊断价值。结果1．OSAHS组血清CysLTs水平为（683．102±89．825）ng／L，显著高于对照组[（461．985±84．951）ng／L]，差异有统计学意义（P〈0．05），且与AHI、最长呼吸暂停时问、睡眠呼吸暂停低通气时间均呈正相关（r=0．417、0．422、0．208，P均〈0．05），与最低血氧饱和度、平均血氧饱和度均呈负相关（r=-0．192、-0．255，P均〈0．05）。2．重度OSAHS组患儿血清CysLTs水平[（773．118±92．015）ng／L]显著高于中度OSAHS组患儿[（712．144±41．331）ng／L]及轻度OSAHS组[（642．206±77．250）ng/L]，差异均有统计学意义（P均〈0．05）。3．患儿血清CysLTs水平（560．872ng/L）为最佳临界点，此临界点的灵敏度（92．7％）和特异度（94．1％）均最高，误诊率和漏诊率较小，诊断符合率为93．3％。4．在OSAHS患儿中汉族患儿血清CysLTs水平[（704．417±77．149）ng/L]高于维吾尔族患儿[（628．053±105．443）ng/L]，差异有统计学意义（P〈0．05）。结论CysLTs水平与OSAHS的严重程度密切相关。不同民族OSAHS患儿血清CysLTs水平具有差异性，汉族患儿血清CysLTs水平高于维吾尔族患儿。血清CysLTs水平可能作为一种血清标志物来初步筛查可疑OSAHS患儿。

Objective To assess the clinical value of the measurement of cysteine leukotriene （CysLTs） con- centration in serum as a diagnostic predictor to screen the obstructive sleep apnea hypopnea syndrome （OSAHS） in children. Methods Serum CysLTs concentration was measured with ELISA kit in 75 patients with snoring before per- forming polysomnography （PSG）. Subsequently, all the subjects underwent PSG test. Forty-one subjects were diagnosed as OSAHS,and 34 subjects didn＇t have OSAHS. These 34 non-OSAHS subjects were served as control group. Among the OSAHS group ,25 subjects were the Han nationality and 12 subjects were the Uyghur nationality. According to apnea hyponea index （AHI）, the OSAHS group was divided into 3 groups, which were light, moderate and severe groups. And the serum CysLTs level of the OSAHS group was taken for correlation analysis with the sleep respiratory, parameters. Compared with the PSG results, the clinical value of the measurement of CysLTs concentration in serum was taken as a diagnostic predictor to screen patients with OSAHS in children. Results 1. The serum CysLTs level of OSAHS group [ （683. 102 ~89. 825） ng/LJ was significantly higher than that in the control group [ （461. 985 ＋ 84. 951 ） ng/L] （P 〈 0.05 ）. And it was correlated positively with AHI,longest apnea time, sleep apnea low aeration time （r = 0. 417, 0.422,0. 208, all P 〈0. 05 ）, but correlated negatively with the lowest oxygen saturation and the mean oxygen saturation （r = -0. 192, -0.255 ,all P 〈 0.05）. 2. The serum CysLTs level [ （773. 118±92. 015） ng/LJ in severe OSAHS group was significantly higher than that in the moderate OSAHS group[ （712. 144±41. 331 ） ng/L] （P 〈0.05） ,and much more significantly higher than that in the light OSAHS group [ （642. 206 ±77. 250） ng/L ~ （ P 〈 0.05 ）. 3. When the serum CysLTs level was 560. 872 ng/L,there was the best critical point with the highest sensitivity rate （92.7%） and specificity rate （94.1% ）, and the lowest misdiagnosis rate and the false dismissal rate, as diagnose accordance rate was 93.3%. 4. The serum CysLTs level of Han[ （704. 417±77. 149） ng/L] was higher than that of Uygur [ （ 628. 053±105. 443 ） ng/L], and there was significant difference between the 2 groups （ P 〈 0.05 ）. Conclusions Serum CysLTs level is closely related with the severity of OSAHS. There is difference in serum CysLTs level between different nationalities. The serum CysLTs level of the Hart nationality is higher than the Uygur nationality. The serum level of CysLTs may be used as a predictor in screening OSAHS children and a biological marker of the severity of OSAHS children.