睡眠呼吸暂停综合征儿童手术前后血浆食欲素A及感觉统合能力的变化

Changes of plasma orexin-A level and behavior performance before and after operation in children withobstructive sleep apnea-hypopnea syndrome

目的探讨睡眠呼吸暂停综合征（obstructivesleepapnea—hypopneasyndrome，OSAHS）儿童手术治疗前后血浆食欲素A（Orexin—A）水平变化及与感觉统合能力的关系。方法接受扁桃体切除和／或腺样体刮除术的儿童OSAHS患者120例，正常对照组30例。并按呼吸暂停低通气指数（apneahypopneain—dex，AHI）将OSAHS组分为轻度组（5次／h≤AHI〈20次／h，n=13）；中度组（20次／h≤AHI〈40次／h，n=76）；重度组（AHII〉40次／h，n=31）。同时按感觉统合能力评分还将OSAHS组分为正常组30名、轻度失调组47名、中度失调组28名、重度失调组15名。术前及术后6个月进行血浆Orexin—A水平测定及儿童感觉统合能力评定。结果OSAHS组患儿血浆Orexin—A浓度[（0．41±0．06）μ/ml]高于正常对照组[（0．31±0．04）μg／ml]，差异有统计学意义CP〈0．01）；不同严重程度OSAHS患儿手术前后血浆Orexin—A浓度比较，轻度组[术前（0．33±0．02）μg／ml，术后（0．28±0．03）μ/ml]、中度组[术前（0．39±0．04）μ/ml，术后（0．29±0．03）μ/ml]、重度组[术前（0．49±0．04）μ/ml，术后（0．32±0．02）μg／ml]差异均有统计学意义（P〈0．01）。AHI指数与术前血浆Orexin—A浓度显著相关（r=0．803，P〈0．01）。感觉统合测评分值与术前血浆Orexin—A浓度也存在显著相关（r=-0．812，P〈0．01）。结论血浆Orexin—A浓度与儿童OSAHS严重程度及其行为认知能力改变关系密切，可能成为儿童OSAHS诊断和预后的血浆标志物。

Objective To explore the changes of plasma orexin-A level before and after operation in ob- structive sleep apnea-hypopnea syndrome （OSAHS） children and its effect on their behavior performance. Methods 120 cases OSAHS children performed tonsillectomy and / or adenoidectomy and 30 cases normal children as con- trol group. According to the AHI index, the OSAHS group was divided into mild group （5 times/h ≤ AHI 〈 20 times/h, n= 13） ,moderate group （20/h ≤AHI 〈40/h, n=76） ,and severe group （AHI /〉 40 times/h, n=31）. And at the same time, according to the sensory integration ratings, OSAHS group was divided into normal group（ n = 30）, mildly abnormal group （ n = 47 ）, moderately abnormal group （ n = 28 ）, severely abnormal group （ n = 15 ）. Before operation and 6 months after operation, plasma orexin-A levels and children＇s sensory integration were meas- ured.Results Plasma orexin-A level of the OSAHS group （ （ 0.41±0.06） μg/ml） was significantly higher com- pared with the control group （ （0.31 ±0.04） μg/ml） （P〈 0.01 ）. In orexin-A level of different A HI groups before and after operation（mild group： （0.33±0.02） μg/ml vs （0.28±0.03） μg/ml, moderate group： （0.39±0.04） μg/ml vs （ 0.29±0.03 ） μg/ml, severe group： （0.49±0.04） μg/ml vs （ 0.32±0.02 ） μg/ml）, there had significant differences （P〈0.01） .In OSAHS children,AHI index had positive correlation with preoperative plasma orexin-A level （ r= 0.803, P〈0.01 ）. There was a significant negative correlation between sensory integration scores and plasma orexin- A level（ r=-0.812, P〈0.01）. Conclusions Plasma orexin-A level of OSAHS children is closely related to the severity of OSAHS and the changes of their behavioral ability.And it may become a diagnostic plasma marker of OSAHS children.