冠心病患者阻塞性睡眠呼吸暂停与血清生化标记物的关系

Relationship Between Obstructive Sleep Apnea and Serum Biological Markers in Patients With Coronary Artery Disease

目的:本研究在接受标准药物治疗的冠心病合并阻塞性睡眠呼吸暂停(OSA)的患者中评价OSA与四种血清生化标志物之间的关系,包括高敏C反应蛋白(hs-CRP)、内皮素-1、氨基末端B型利钠肽原(NT-proBNP)、纤维蛋白原;并评价持续气道正压通气(CPAP)对这些标志物因子的影响。方法:入选151名确诊冠心病并接受标准药物治疗的患者,经多导睡眠监测后,根据睡眠呼吸暂停低通气指数(AHI)分为四组:无OSA组:AHI<5次/小时(n=25);轻度OSA组:5次/小时≤AHI<15次/小时(n=50);中度OSA组:15次/小时≤AHI<30次/小时(n=43);重度OSA组:AHI≥30次/小时(n=33)。基线时检测所有患者空腹高敏C反应蛋白、内皮素-1、氨基末端B型利钠肽原、纤维蛋白原的水平,重度OSA患者经三个月的持续气道正压通气治疗后重复检测上述四种因子。结果:在重度OSA组中高敏C反应蛋白水平较无OSA组和轻度OSA组患者显著升高(P<0.001,P<0.003);经校正混杂因素后,高敏C反应蛋白与AHI、氧减指数(ODI)显著相关(分别为r=0.439,P<0.001;r=0.445,P<0.001)。多元线性逐步回归分析提示:与高敏C反应蛋白水平相关性最强的指标是氧减指数(R=0.502,P<0.001),其次为年龄(R=-0.214,P=0.005)和性别(R=0.188,P=0.018)。重度OSA组中,CPAP显著减低高敏C反应蛋白水平[(4.18±3.26)mg/L至(2.27±2.42)mg/L,P=0.005]。结论:在接受标准药物治疗的冠心病患者中,高敏C反应蛋白水平与OSA的严重程度显著相关,而且CPAP治疗可以显著降低高敏C反应蛋白水平。

Objective： To investigate the relationship between obstructive sleep apnea （OSA） and 4 serum biomarkers m patients of coronary artery disease （CAD） with OSA who received standard medication, and to study the effect of continuous positive airway pressure （CPAP） treatment on those 4 biomarkers. Methods： A total of 151 above mentioned patients received polysomnography and divided into 4 groups according to apneaehypopnea index （AHI）. （1）No OSA group, AHI〈5, n=25, （2） Mild OSA group, 5≤AHI〈15, n=50, （3） Moderate OSA group, 15 ≤ AHI〈30, n=43 and （4） Severe OSA group, AHI ≥ 30, n=33. The 4 serum biomarkers of high sensitivity C-reactive protein （hs-CRP）, endothelin-1 （ET-1）, N-terminal proB-type natriuretic peptide （NT-proBNP） and fibrinogen were examined at the baseline and fasting condition in all patients, and were re-examined after 3 months of CPAP treatment in Severe OSA group. Results： The hs-CRP level was obviously higher in Severe OSA group than those in No OSA group and Mild OSA group, P〈0.001 and P〈0.003. With adjusted confounders, the hs-CRP level was correlated to AHI and oxygen desaturation index （ODI）, r=0.439, P〈 0.001 and r=0.445, P〈 0.001. The multiple linear regression analysis indicated that hs-CRP level was strongly and accordingly related to ODI, R=0.502, P〈 0.001, followed by age, R=- 0.214, P=0.005, gender, R=0.188, P=0.018. In Severe OSA group, 3 months CPAP treatment significantly decreased hs-CRP level as （4.18±3.26） mg/L to （2.27±2.42） mg/L, P=0.005. Conclusion： The hs-CRP level was related to severity of OSA, CPAP treatment could significantly decrease hs-CRP level in CAD patients with standard medication.