阻塞性睡眠呼吸暂停低通气综合征患者血清晚期氧化蛋白产物水平与认知功能的关系

The relationship of patients with obstructive sleep apnea hypopnea syndrome whose serum advanced oxidation protein levels and cognitive function

目的观察OSAHS患者认知功能及血清晚期氧化蛋白产物（AOPP）水平的变化，并分析其相关性。方法顺序纳入2013年盐城市第一人民医院呼吸科就诊的67例OSAHS患者（OSAHS组），其中男49例，女18例，年龄21～67岁，平均（44±9）岁；同期收集20名健康志愿者（对照组），其中男14名，女6名，两组体质量指数及一般情况相匹配；分别进行多导睡眠图（PSG）监测，根据睡眠呼吸暂停指数（AHI）分为轻中重度；应用Epworth嗜睡评分量表（ESS）、简易智能状态量表（MMsE）及画钟试验评估白天嗜睡程度及认知功能，并检测血清氧化应激指标AOPP、超氧化物歧化酶（SOD）和丙二醛的水平。OSAHS组中15例经持续正压通气（cPAP）治疗（治疗组），观察上述指标治疗前后的变化。结果与对照组比较，OSAHS组及治疗组的MMSE、画钟试验评分降低。与重度0SAHS组比较，治疗组MMSE、画钟试验评分升高。OSAHS组MMSE评分中注意力及计算力、记忆（尤其是短时记忆）评分明显降低[分别为（4．73±0．81）～（2．69±1．38）和（2．85±0．61）～（1．92±0．62）]。与对照组比较，OSAHS组及治疗组的血清AOPP和丙二醛水平升高[分别为（78±20）～（117±20）Mmol／L和（2．9±1．0）～（6．1±3．0）μmol／L]，而SOD水平降低[（89±8）～（57±9）U／ml。与重度OSAHS组比较，治疗组血清AOPP、丙二醛水平降低，SOD水平升高。所有受试者（指OSAHS组及治疗组，不包括对照组，下同）MMSE、画钟试验评分与PSG相关指标（基础SaO2、最低SaO2、AHI、LA／HT、SLT90％）均分别相关。所有受试者血清AOPP、丙二醛、SOD水平与PSG相关指标（最低SaO2、AHI、LA／HT、SLT90％）均分别相关，且差异有统计学意义。血清AOPP、丙二醛、SOD水平与MMSE、画钟试验评分相关，血清AOPP水平与丙二醛、SOD相关，差异有统计学意义。结论OSAHS患者认知功能障碍与病情的严重程度有关，且主要表现为短时记忆能力和计算能力等方面受损；AOPP是反映OSAHS患者体内蛋白氧化损伤的早期敏感指标，且与其认知功能障碍密切相关。

Objective To observe the change of patients with obstructive sleep apnea hypopnea syndrome （OSAHS） whose cognitive function and serum advanced oxidation protein （AOPP） levels,and analyze its correlation. Methods Sixty seven patients with OSAHS （OSAHS group） ,of the Department of Respiration of First People＇s Hospital of Yancheng in 2013 were the sequence included,there were 49 cases of men patients, 18 cases of women patients, they were from 21 to 67,average ages were （44± 9）. At the same period,20 healthy volunteers were selected as （control group）, there were 14 men, 6 women, A BM1 and the general situation of two groups were matched, they were given respectively polysomnography （PSG） monitoring,according to the sleep apnea index （AHI）, were divided into mild to moderate and severe. Epworth sleepiness scale （ESS） was applied, Mini Mental State Examination （MMSE） and clock drawing test to evaluated the degree of daytime sleepiness and cognitive function, and detected serum oxidative stress indices AOPP,superoxide dismutase （SOD） and the levels of malondialdehyde. In group OSAHS, 15 cases were given continuously positive airway pressure （CPAP） treatment （treatment group） ,and observed the changes of above indexes before and after treatment. Results Compared with the control group,MMSE and the clock drawing test score of OSAHS group and treatment group were lower. Compared with the severe OSAHS group, MMSE, clock drawing test scores of treatment group increased. MMSE score of OSAHS group whose attention, computing power, memory （especially short term memory） was significantly reduced respectively [（4.73±0.81）-（2.69± 1.38） and （2.85±0.61）- （1. 92±0.62）1. Compared with the control group, serum AOPP and MDA levels of OSAHS group and treatment group increased,were separately [（78±20）-（117±20）μmol/L and （2.94±1.0）-（6.1±3.0）μmol/L],and reduced levels of SOD E（89± 8）-（57±9） U/ml]. Compared with the severe OSAHS group, serum AOPP, malondialdehyde levels decreased, the level of SOD increased. All subjects （OSAHS group and treatment group,did not include a control group, the same below） MMSE, clock drawing test score and PSG related index （SaO2, the lowest SaO~, AHI based, LA/HT, SLT90% ） were related to, they had statistical significance. The serum levels of AOPP, MDA, SOD level and MMSE, clock drawing test score related, serum levels of AOPP and MDA,SOD correlation, the difference has statistical significance. Conclusions Patients with OSAHS whose cognitive dysfunction is related to the severity of symptoms, and the main performance is for the short-term memory capacity and computing ability damage. AOPP is a sensitive index to reflect the early oxidative protein damage in patients with OSAHS, and is closely related to cognitive dysfunction.