持续气道正压通气对重叠综合征患者血清中相关炎症因子水平的影响

Effects of continuous positive airway pressure treatment of inflammatory factors in patients with overlap syndrome

目的 探讨持续气道正压通气（CPAP）对重叠综合征（OS）患者血清中相关炎症因子水平的影响.方法 选取2012年3月至2013年9月在南京医科大学第一附属医院呼吸科病房及所属睡眠呼吸障碍中心就诊的阻塞性睡眠呼吸暂停综合征（OSAS）或慢性阻塞性肺疾病（简称慢阻肺）或OS患者74例,根据多导睡眠图（PSG）监测及肺功能测定结果将其分为OSAS组（25例）,慢阻肺组（26例）及OS组（23例）,通过酶联免疫吸附（ELISA）法测定患者血清中C反应蛋白（CRP）、肿瘤坏死因子α（TNF-α）及非对称性二甲基精氨酸（ADMA）的水平,比较接受CPAP治疗的OSAS组和OS组患者治疗前和CPAP治疗30 d时血清中上述相关炎症因子水平的变化.结果 CPAP治疗前OSAS组、慢阻肺组、OS组血清CRP水平分别为（7.2±6.6）、（8.4±6.8）、（8.5±7.9）mg/L,TNF-α水平分别为（33±13）、（52±34）、（41±33）ng/L,组间差异均无统计学意义（均P〉0.05）,而OSAS组血清ADMA水平显著低于慢阻肺组[（0.50±0.08）比（0.71±0.31）μmol/L,P=0.002].OSAS组和OS组治疗前后血清ADMA水平差异均无统计学意义（均P〉0.05）;治疗后血清CRP[（4.5±4.2）和（5.5±4.1）mg/L]及TNF-α水平[（31±9）和（35±24）ng/L]均较治疗前显著下降（均P＜0.05）,但2组间差异均无统计学意义（均P〉0.05）.结论 CPAP治疗可显著降低OSAS及OS患者血清中CRP及TNF-α水平,提示其可改善此类患者的炎症反应.

Objective To explore the effects of continuous positive airway pressure （CPAP） treatment on the serum levels of associated inflammatory factors in patients with overlap syndrome （OS）. Methods Seventy-four patients with obstructive sleep apnea syndrome （OSAS） or chronic obstructive pulmonary disease （COPD） or overlap syndrome （OS） were recruited from Department of Respirology and Affiliated Sleep Center of our hospital from March 2012 to September 2013. They were divided into OSAS （ n = 25 ）, COPD （ n = 26 ） and OS （ n = 23 ） groups according to the results of polysomnography （PSG） and spirometry. By enzyme linked immunosorbent assay （ELISA） ,the serum levels of C-reactive protein （CRP） , tumor necrosis factor-alpha （TNF-oL） and asymmetric dimethylarginine （ADMA） were measured and compared before and at Day 30 post-CPAP in OSAS and OS groups. Results At pre-Cl？AP, there was no statistical difference in serum levels of CRP （ （7.2 ± 6.6）, （ 8.4 ± 6. 8 ）, （ 8.5 ± 7. 9 ） mg/L） and TNF-a （ （33 ± 13 ）, （52 ± 34）, （41 ± 33 ） ng/L） among OSAS, COPD and OS groups （ all P 〉 0. 05 ）. However, serum ADMA level in OSAS group were significantly lower than those in COPD group （ （ 0. 50 ± 0. 08 ） vs （0.71 ± 0.31 ） umol/L, P = 0.002） . Compared with before and at Day 30 post-CPAP, although no significant difference existed in serum levels of ADMA （ all P 〉 0. 05 ） , at Day 30 post-CPAP there were significantly lower serum levels of CRP （ （4. 5 ±4. 2） and （5.5 ±4. 1 ） mg/L） and TNF-a levels （ （31 ± 9） and （35 ± 24） ng/L） than those pre-CPAP in OSAS and OS groups respectively （all P 〈 0.05）. No significant difference existed between OSAS and OS groups （ all P 〉 0. 05）. Conclusion CPAP treatment significantly reduces the serum levels of CRP and TNF-a so as to improve inflammation responses in OS and OSAS patients.