高原地区中重度OSAHS合并PAH的发生机制及CPAP的干预作用

Pathogenesis of moderate-severe OSAHS complicated with PAH and interfering effect of CPAP at high altitude area

目的探讨高原中重度OSAHS合并PAH的发生机制及CPAP的干预作用。方法 86例患者分为单纯OSAHS组(38例)和合并PAH组(48例)。所有患者监测PSG、mPAP、血浆ET-1、NO、血清8-isoPGF2α、SOD、T-AOC。合并PAH组在CPAP治疗13周后,重复以上测定。结果与单纯OSAHS组比较,合并PAH组AHI、mPAP、血浆ET-1、血清8-iso-PGF2α明显增高,m Sa O2、血浆NO、SOD、T-AOC明显降低(均P<0.01)。mPAP与AHI、血浆ET-1、血清8-iso-PGF2α显著正相关,与睡眠m Sa O2、血浆NO、血清SOD、T-AOC显著负相关(均P<0.01)。合并PAH组经CPAP治疗后,AHI、mPAP、血浆ET-1和血清8-iso-PGF2α明显降低,睡眠m Sa O2、血浆NO、血清SOD、T-AOC明显升高。结论 OSAHS患者PAH的形成可能与CIH引起氧化应激、ET-1和NO比例失衡、内皮功能障碍有关。CPAP通气治疗能有效地消除睡眠呼吸暂停和CIH,减轻这些损害,从而降低PAH。

Objective To explore the pathogenesis of moderate-severe OSAHS complicated with PAH and interfering effect of CPAP ventilation at high altitude area. Methods 86 patients with OSAHS were divided into the simple OSAHS group （38 cases） and the PAH complication group （48 cases）. Their PSG, AHI, MSO2, mPAP, plasma ET-1, NO, serum 8-iso-PGF2α, SOD and T-AOC were measured in all patients, and the above indexes were repeatedly measured in the PAH group 13 weeks after CPAP treatment. Results Compared with the simple OSAHS group, the levels of AHI, mPAP, plasma ET-1 and serum 8-iso-PGF2α were significantly higher, and the levels of mSaO2 , plasma NO, serum SOD and T-AOC were significantly lower in the PAH complication group （ all P 〈 0. 01 ）. mPAP was positively correlated with AHI, ET-1 and 8-iso-PGF2α, and negatively correlated with mSaO2, NO, SOD and T-AOC （ all P 〈 0.01 ）. The levels of AHI, mPAP, plasma ET-1 and serum 8-iso-PGF2α decreased significantly, and the levels of mSaO2, plasma NO, serum SOD and T-AOC increased significantly in the PAH complication group 13 weeks after the treatment （ all P 〈 0. 01 ）. Conclusion The formation of PAH in OSAHS patients may he related with oxidative stress caused by CIH, ET-1 and NO imbalance and impaired pulmonary vascular endothelial function. CPAP can effectively dismiss sleep apnea and CIH, improve these damages and reduce the incidence of PAH in OS- AHS patients.