血栓前状态的相关因子在冠心病合并睡眠呼吸暂停患者中的变化规律

Changes of substances of prethrombotic state in patients of coronary heart disease with obstructive sleep apnea-hypopnea syndrome

目的探讨血栓前状态相关因子在冠心病合并阻塞性睡眠呼吸暂停患者中的变化及意义。方法 50例冠心病做对照组,61例冠心病合并OSAHS(OSAHS组)经多导睡眠监测系统监测,记录睡眠呼吸暂停低通气指数(apnea hypopnea index。AHI),分为轻、中、重度三组。所有对象于深睡眠期及晨醒1h,分别抽取外周血5ml离心,检测组织纤溶酶原激活物(t-PA),纤溶酶原激活物抑制因子1(PAI-1),血管性血友病因子(vWF)。结果 OSAHS组t-PA活性明显低于对照(P<0.001);PAI-1活性及vWF含量明显高于对照组(P<0.001)。OSAHS组重度组t-PA活性明显低于中度、轻度组、PAI-1活性明显高于中度、轻度组(P<0.001),而中度、轻度组之间t-PA活性、PAI-1活性差异均无显著意义(P>0.05);vWF在重度、中度、轻度组三者之间差异无显著意义(P>0.05)。结论 OSAHS可以导致t-PA活性下降、PAI-1、vWF水平升高,从而加重冠心病血栓事件的发生、发展。vWF与轻中度缺氧程度的相关性要强于t-PA。

Objective To explore the correlation between the substances of prethrombotic state in patients of coronary heart disease（CHD） with obobstructive sleep apnea- hypopnea syndrome （OSAHS）. Methods Totally 50 cases of CHD were selected as the control group;61 cases of CHD with OSAHS detected by polysomnograp and classified into three groups according to the resuhs of apnea hypopnea index（AHI） ：light,middle and severe group. Blood samples were drawn in the time spots of deep sleep and 1 h after morning wake up. Plasma tissue plasminogen avtivator（ t -PA） and plasminogen avtivator inhibitor - 1 （PAI - 1 ） activities and the concentration of von willbrand factor （vWF） were meas- ured. Results The activity of t - PA in OSAHS were lower than the control group but the activity of PA - 1 were higher than those the control group. The activity of t - PA and PA - 1 in the severe group of OSAHS were lower or higher than those the middle and the light ; The activity of t - PA did not differ between the light and the middle ; The concentration of vWF did not differ between the three groups. Conclusion OSAHS can cause the lower activity of t - PA and the higher activity of PA - 1 and vWF,the changes can cause the prethrombotic state in CHD, the occurrence between vWF and light or middle hypoxia is significant than t - PA and PA - 1.