血清同型半胱氨酸与阻塞性睡眠呼吸暂停低通气综合征患者氧化应激的关系

Relationship between serum homocysteine level and oxidative stress in patients with obstructive sleep apnea-hypopnea syndrome

目的：探讨血清同型半胱氨酸（ Hcy ）与阻塞性睡眠呼吸暂停低通气综合征（ OSAHS ）患者氧化应激的关系。方法选取2008年6月至2013年12月就诊于苏州大学附属第一医院睡眠中心且经多导睡眠图（ PSG ）监测确诊为OSAHS的患者117例，根据监测结果分成3组：轻度组（41例）、中度组（40例）、重度组（36例）；另选取同期经PSG监测AHI＜5次/h的33名健康体检者为对照组。所有受试者均记录睡眠呼吸监测相关指标，晨起采集空腹静脉血4 ml，采用循环酶法测定Hcy，紫外分光光度比色法测定丙二醛及谷胱甘肽。结果血清丙二醛水平：重度组显著高于对照组、轻度组、中度组[（7.3±1.0）比（4.6±0.9）、（5.4±1.3）、（6.8±0.7）μmol/L]（均P＜0.05）。血清谷胱甘肽水平：轻、中度组均显著高于对照组[（6.5±2.1）、（7.5±1.5）比（4.2±1.4） mg/L]（均P＜0.05），但重度组[（4.6±1.4）mg/L]与对照组差异无统计学意义（P＞0.05）。血清Hcy水平：轻、中度组均显著高于对照组[（10.3±2.0）、（13.3±2.6）比（8.7±0.7）μmol/L]（P＜0.05），但重度组[（9.5±1.8）μmol/L]与对照组差异无统计学意义（P＞0.05）。剔除重度组后，多元逐步线性回归分析显示Hcy水平与年龄、丙二醛、谷胱甘肽、AHI、氧减指数均具有相关性（ P＝0.011、0.005、0.008、0.001、0.016）。结论氧化应激损伤水平与抗氧化水平在OSAHS患者疾病的不同阶段，变化不完全一致。 Hcy的改变与抗氧化水平谷胱甘肽改变同步，与疾病的严重程度不同步。氧化应激的作用可能是OSAHS患者血清Hcy水平改变的内在机制。

Objective To explore the relationship between serum homocysteine （ Hcy ） level and oxidative stress in patients with obstructive sleep apnea-hypopnea syndrome （ OSAHS）.Methods Patients undergoing overnight full polysomnography （ PSG ） were selected from Sleep Disorders Center at First Affiliated Hospital between June 2008 and December 2013.A total of 117 OSAHS patients were recruited and divided into 3 groups of mild （ n =41 ） , moderate （ n=40 ） and severe （ n =36 ）.And they were compared with the controls （ n =33 ）.The PSG variables were recorded and the contents of Hcy , malonaldehyde （ MDA ） and glutathione （ GSH ） detected after sleep.Serum Hcy was measured by cyclophorase.And MDA and GSH were measured by spectrophotometer.Results The concentrations of MDA in severe group were higher than those in the other three groups （ （ 7.3±1.0 ） vs （ 4.6 ±0.9 ） , （5.4 ±1.3）, （6.8±0.7） μmol/L, all P〈0.05）.The concentrations of GSH in mild and moderate groups were both higher than the controls （ （ 6.5 ±2.1 ） , （ 7.5 ±1.5 ） vs （ 4.2 ±1.4 ） mg/L, all P＆lt;0.05）.However there was no significant difference between severe group （（4.6 ＆#177;1.4） mg/L） and controls （P〈0.05）.The Hcy level in mild and moderate groups were both higher than the controls （（10.3 ±2.0）, （13.3 ±2.6） vs （8.7 ±0.7） μmol/L, all P〈0.05）.However there was no significant difference between severe group （ （ 9.5±1.8 ） μmol/L ） and controls （ P 〈0.05 ）.When severe group was removed , multielement linearity regression analysis indicated that there was a statistically significant relationship between Hcy concentration and age , MDA, GSH, apnea hypopnea index （ AHI） and oxygen desaturation index （ ODI） （ P =0.011, 0.005, 0.008, 0.001, 0.016 respectively ）.Conclusions The change of marker levels in oxidative stress is not entirely consistent with the antioxidant levels in OSAHS patients at different stages of disease.The change of Hcy level is proportional to GSH level , but not proportional to severity in OSAHS patients.The mechanism of serum Hcy change may be oxidative stress in OSAHS patients.