儿童睡眠呼吸暂停与血浆血管内皮生长因子和肿瘤坏死因子α的相关性研究

Relationship between plasma vascular endothelial growth factor and tumor necrosis factor-alpha and obstructive sleep apnea hypopnea syndrome in children

目的了解血浆血管内皮生长因子（vascularendothelialgrowthfactor，VEGF）和肿瘤坏死因子α（tumornecrosisfactor．alpha，TNF-α）在儿童阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患儿体内的变化，探讨OSAHS患儿血浆VEGF和TNF-α水平与体质量指数（BMI）及多道睡眠图（PSG）记录数据的关系。方法2008年10月至2009年3月中山大学附属第一医院共80例患儿纳入临床研究，其中有打鼾症状儿童60例，无打鼾症状及无OSAHS症状儿童20例为对照组。酶联免疫吸附实验（enzyme—linkedimmunosorbentassay，ELISA）法检测血浆VEGF和TNF—α。60例有打鼾症状儿童行PSG监测，计算每位患儿的整夜平均氧饱和度（wholenightmeansaturation，MSaO2）、最低氧饱和度（LSaO2）、低氧饱和事件累积时间占总睡眠时间的比率（desatuationcumulatetime／totalsleeptime，DCT／TST）、低氧饱和度指数3（oxygendesaturationindex3，ODl3）、呼吸暂停低通气指数（AHI）、阻塞性呼吸暂停指数（obstructiveapneaindex，OAI）。采用SPSS13．0软件对数据进行分析。结果OSAHS组血浆VEGF和TNF—α水平（540．45pg／ml和311．94pg／ml）均高于单纯鼾症组（234．45pg／ml和97．55pg／ml）及对照组（259．80pg／ml和120．70pc,／ml），差异有统计学意义（HC值分别为14．176和15．571，P值均〈0．05）；单纯鼾症组与对照组相比较血浆VEGF和TNF—α水平差异均无统计学意义（P值均〉0．05）。OSAHS患儿血浆VEGF和TNF-α水平在中重度低氧血症组与轻度低氧血症组间差异无统计学意义（P值均〉0．05）。Spearman秩相关分析发现，OSAHS患儿血浆VEGF和TNF—α水平分别与LSaO2、MSaO2、OD13、DCT／TST、OAI、AHI以及BMI无明显相关性（r值均〈0．5，P值均〉0．05）。结论VEGF、TNF—α在OSAHS患儿体内升高，对进一步了解OSAHS患儿的病理生理改变有一定的临床意义。

Objective To investigate the relation of plasma vascular endothelial growth factor （VEGF） and tumor necrosis factor-α（TNF-α） with obstructive sleep apnea-hypopnea syndrome（OSAHS） in children. Methods Eighty children were recruited from October 2008 to March 2009, including 60 children with snoring and 20 healthy children without snoring as control. Plasma VEGF or TNF-α concentration was measured by enzyme-linked immunosorbent assay （ELISA） respectively. Sixty children with snoring underwent an overnight polysomnography test their PSG data, including whole night mean saturation （MSaO2）, lowest oxygen saturation （LSaO2）, desatuation cumulate time/total sleep time （DCT/TST）, oxygen desaturation index 3 （ODI3）, apnea-hypopnea index （AHI）, obstructive apnea index （OAI）, were collected and analysed. SPSS 13.0 software was used to analyze the data. Results The levels of plasma VEGF and TNF-α in children with OSAHS（540. 45 pg/ml and 311.94 pg/ml） were higher than those in children with snoring alone （234. 45 pg/ml and 97.55 pg/ml） or those in healthy children （259. 80 pg/ml and 120. 70 pg/ml） , with statistically significant differences （ HC value ： 14. 176 and 15. 571, P 〈 0. 05, respectively）, but with no statistical difference between children with snoring alone and healthy children （ P 〉 0. 05 ）. The differences in plasma VEGF or TNF-α levels between children with moderate and severe hypoxemia and children with mild hypoxemia were not statistically significant （ P 〉 0.05 ）. Spearman rank correlation analysis showed no significant correlation between plasma level of VEGF or TNF-α and LSaO2 , MSaO2, ODI3, DCT/TST, OAI, AHI or BMI （r values were 〈 0. 5, P 〉 0. 05）. Conclusion Plasma levels of VEGF and TNF-α increase in children with OSAHS.