同期多平面手术对中青年中-重度OSAHS患者血清氧化应激水平和认知功能的影响

Effects of simultaneous multi-level surgery intervention on the changes of the oxidative stress and the cognitive function in young and middle-aged patients with Moderate-severe obstructive sleep apnea hypopnea syndrome

目的:探讨同期多平面手术对中青年中-重度OSAHS患者血清氧化应激水平和认知功能的影响。方法:116例中青年中-重度OSAHS患者接受同期多平面手术治疗。术前及术后6个月测定PSG相关指标,血清丙二醛(MDA)、晚期蛋白氧化产物(AOPP)和8-异前列腺素F2α(8-iso-PGF2α)水平,利用MoCA、MMSE和ESS量表评估认知功能和白天嗜睡程度,并进行统计学分析。结果:①术后6个月AHI、TS90%、LSaO_2数值均较术前明显改善(P<0.01)。全部患者未出现严重并发症。②MoCA、MMSE评分分别为(23.52±2.64)分和(26.54±1.07)分,OSAHS患者术前存在认知功能障碍,MoCA评分与AHI、TS90%、MDA、AOPP和8-iso-PGF2α呈负相关,与LSaO_2呈正相关(r分别为-0.233、-0.190、-0.256、-0.247、-0.221和0.215,P<0.05)。认知功能损伤主要表现在视空间与执行功能、记忆与延迟回忆(主要以短期记忆为主)方面。③与术前相比,术后MoCA和MMSE评分均升高(P<0.05);MDA、AOPP和8-iso-PGF2α水平及ESS评分均显著降低(P<0.05)。且术后患者MoCA评分分别与MDA、AOPP、8-iso-PGF2α、AHI、TS90%呈负相关,与LSaO_2呈正相关(r分别为-0.495、-0.463、-0.397、-0.332、-0.292和0.336,P<0.05)。结论:中青年中-重度OSAHS患者认知功能障碍与体内氧化应激水平密切相关,同期多平面手术通过降低全身氧化应激水平进而改善认知功能。

Objective：To explore the effects of simultaneous multi-level surgery intervention on the changes of the oxidative stress and the cognitive function in young and middle-aged patients with moderate-severe OSAHS.Method：One hundred and sixteen young and middle-aged patients with moderate-severe OSAHS received simultaneous multi-level surgery.PSG,malondialdehyde（MDA）,advanced oxidation protein products（AOPP） and 8-isoprostane F2α（8-iso-PGF2α）were tested,together with the evaluation of the questionnaires of Montreal cognitive assessment（MoCA）,mini-mental state examination（MMSE） and Epworth sleepiness scale（ESS） before and 6 months after surgery.Result：① The AHI,TS90% and LSaO2 were all improved significantly 6 months after operation.No severe complications were observed in any patient.②The preoperative MoCA and MMSE scores were（23.52±2.64） and（26.54±1.07）,respectively.The cognitive impairment were detected in OSAHS patients.MoCA was negatively correlated with AHI,TS90%,MDA,AOPP and 8-iso-PGF2α,while positively correlated with LSaO2（P〈0.05,r=-0.233,-0.190,-0.256,-0.247,-0.221 and 0.215,respectively）.Cognitive impairment was mainly manifested as disorder in the visual space and executive function,memory and delayed recall（mainly short-term memory）.③ MoCA and MMSE scores were both increased（P〈0.05） after the operation.MoCA showed negative correlations with MDA,AOPP,8-iso-PGF2α,AHI and TS90%,and positive correlation with LSaO2（P〈0.05,r=-0.495,-0.463,-0.397,-0.332,-0.292 and 0.336,respectively）.Conclusion：Oxidative stress and cognitive dysfunction are closely related in young and middle-aged patients with Moderate-severe OSAHS.Oxidative stress may play an important role in cognitive function of young and middleaged patients with Moderate-severe OSAHS.Multi-level surgery can improve oxidative stress so that to improve cognitive impairment.