阻塞性睡眠呼吸暂停低通气综合征患者血清心肌营养素-1及钙调素依赖蛋白激酶Ⅱ的临床意义

A study of the CT-1 and CaMK K level in patients with obstructive sleep apnea-hypopnea syndrome

目的观察0SAHs患者血清中心肌营养素-1（CT-1）及钙调素依赖蛋白激酶Ⅱ（CaMKII）Tk平的变化情况，并通过超声心动图检测右心室等容加速度（RVIVA）以评估OSAHS患者早期心功能的改变。方法选取不同严重程度的OSAHS患者60例，并选取单纯肥胖者20例作为对照组，均行〉7h的多导睡眠监测，并测定患者CT-1及CaMKlI的血清水平，同时对所有人选对象中的对照组和0SAHS患者重度组行心脏组织多普勒超声，测量RVIVA。结果①与单纯肥胖组比较，OSAHS各组中CT-1血清水平、CaMKII血清水平均明显升高，差异有统计学意义（P〈O．05）。且两者血清水平的升高均与OSAHS病情严重程度呈正相关，差异有统计学意义（P〈O．05）。相关分析显示：CT-1血清水平与呼吸紊乱指数（AHI）、CaMKⅡ血清水平呈正相关（r=0．732，0．794，P〈0．01），与最低血氧饱和度（LSa02）呈负相关（r=-0．583，P〈0．01）；CaMKII血清水平与AHI呈正相关（r=0．697，P〈0．01），与LSaOz呈负相关（r=-0．641，P〈O．01）。②与对照组比较，0SAHS组虽无明显临床症状，但RVIVA值已出现明显降低，差异有统计学意义（P〈O．05），相关分析显示RVIVA水平与AHI呈负相关（r=-0．566，P〈0．01）。③将CT_1及CaMKII的浓度与RVIVA进行相关分析，发现C-1、CaMKⅡ两者均与RVIVA无相关性。结论0SAHs可引起CT-1及CaMKII的血清水平增高，且其增高程度与OSAHS病情的严重程度密切相关，OSAHS患者在临床无任何并发症存在时即可出现右心功能的下降。。

Objective To observe the changes of plasma cardiotrophin 1（CT-1） and calmodulin- dependent protein kinase Ⅱ （CaMK Ⅱ） levels in patients with obstructive sleep apnea-hypopnea syndrome （OSAHS）, and evaluate early changes of the cardiac function in OSAHS patients using ultrasonic heartbeat graph examination right ventricular isovolumic acceleration （RVIVA）. Methods Randomly selected 60 patients with different levels of OSAHS. And to choose 20 simple obesity patients as control group. All the tested people received more than 7 hours of polysomnogram monitoring, then took the plasma to measure CT-1 and CaMK Ⅱ level. While the severe OSAHS group and control group were detected the RVIVA using tissue Doppler echoeardiOgraphy. Results （1）Compared with the simple obesity group, the levels of CaMK V and CT-1 in OSAHS groups elevated obviously （ P 〈0.05）. The increase of CT-1 and CaMK Ⅱ＇s expression was closely associated with OSAHS severity. CT-1 level was positively correlated with AHI,CaMKⅡ （ r = 0. 732,0. 794, P 〈0.01）, and negatively correlated with LSaO2 （ r = -0. 583, P 〈0. 01） ,just as CT-1, CaMK Ⅱ also was positively correlated with AHI（ r = 0. 697, P 0.01）and negatively correlated with LSaO2 （ r = -0. 641, P 〈0.01）. （2）Compared with the obese control group, OSAHS group did not have any clinical symptoms, but RVIVA decreased signi{icantly in OSAHS group （ P 〈0.05）. There was a negative correlation between RVIVA and AHI （r = -0. 566, P 〈0.01）. （3）Through correlation analysis, {ound that CT-1, CaMK lI both has no correlation with RVIVA. Conclusions CT-1 and CaMK Ⅱ＇s expression increased in patients with OSAHS. The increase of CT-1 and CaMKⅡ ＇s expression was closely associated with OSAHS severity. OSAHS patients had right heart function decline,even if they are no clinical complications exist, and the decline was correlated with the severity of OSAHS.