阻塞性睡眠呼吸暂停综合征患者血清新喋呤水平与白天嗜睡度的相关性分析

The correlation analysis between serum neopterin and daytime sleepiness in OSAHS patients

目的分析阻塞性睡眠呼吸暂停综合征(OSAHS)患者血清新喋呤(NP)水平与白天嗜睡度的相关性。方法选择2014年10月—2015年5月于河北省唐山市协和医院呼吸科就诊的OSAHS患者80例为OSAHS组,根据呼吸暂停低通气指数(AHI)指标分为轻度亚组20例,中度亚组32例,重度亚组28例。选择同期健康体检者50例为健康对照组。测量2组血清新喋呤水平,并采用多导睡眠仪监测其夜间睡眠,记录AHI、最低血氧饱和度(LSaO_2)以及最长呼吸暂停时间(Tmax),进行Epworth嗜睡度量表(ESS)、躯体疲劳等评分。对OSAHS患者NP水平与白天嗜睡度的相关性进行分析。结果 OSAHS组新喋呤水平较健康对照组明显升高[(7.7±0.8)ng/ml vs.(3.3±0.4)ng/ml,P<0.05];ESS评分、AHI、Tmax均明显高于健康对照组[(10.6±3.1)分vs.(5.3±1.7)分,(36.6±5.5)次/min vs.(1.1±0.3)次/min,(55.2±11.5)s vs.(2.9±0.3)s,P均<0.05],而LSaO_2低于健康对照组[(79.6±10.9)%vs.(94.5±3.7)%,P<0.05];躯体疲劳、脑力疲劳均明显高于健康对照组[(7.25±1.93)分vs.(5.10±1.87)分,(5.87±0.29)分vs.(3.53±0.68)分,P<0.05]。OSAHS患者中,轻度亚组NP水平<中度亚组<重度亚组[分别为(11.23±1.82)ng/ml、(13.35±1.87)ng/ml、(15.50±1.86)ng/ml,F=6.058,P=0.016]。相关性分析提示血清NP水平与BMI、AHI、Tmax、LsaO_2、躯体疲劳、脑力疲劳均存在一定的正相关(r=0.383、0.207、0.247、0.289、0.507、0.533,P<0.05)。ESS评分与AHI、Tmax、LsaO_2、躯体疲劳评分和脑力疲劳评分存在一定的正相关(r=0.255、0.435、0.380、0.322、0.385,P<0.05);ROC曲线分析提示血清NP预测诊断OSAHS患者的AUC为0.798,cut—off值为6.9 ng/ml,敏感度为84.4%,特异度为86.1%。结论血清新喋呤可以作为评价OSAHS严重程度和疲劳感加重的参考指标。

Objective To analyse the correlation of obstruction sleep apnea hypopnea syndrome（OSAHS） patients serum neopterin（NP） and the level of daytime sleepiness.Methods From October 2014 toMay 2015,80 patients with OSAHS in Tangshan City Union Hospital,Hebei Province were enrolled as OSAHS group,according to apnea hypopnea index（AHI） index,they were divided into mild subgroup（20 cases）,moderate subgroup（32 cases）,severe subgroup（28 cases）.Fifty cases of healthy persons were selected as healthy control group.Measured two groups＇ serum neopterin levels,and used of polysomnography for monitoring the night sleep,recording AHI,the lowest oxygen saturation（SaO_2） and the longest respiratory pause time（Tmax）,the Epworth sleepiness metrics score（ESS）,physical fatigue.The correlation between NP levels and daytime sleepiness in patients with OSAHS was analyzed.Results The OSAHS group＇ s new neopterin levels compared with the healthy control group was significantly increased[（7.7±0.8） ng/ml vs.（3.3 ±0.4） ng/ml,P〈0.05];the ESS score and AHI,Tmax were significantly higher than those in healthy control group[（10.6 ±3.1） vs.（5.3 ± 1.7）,（36.6±5.5） times/minvs.（1.1 ±0.3） times/min,（55.2 ± 11.5） s vs.（2.9±0.3） s,P〈0.05],and LSa02 was lower than healthy group[（79.6 ± 10.9）%vs.（94.5 ±3.7）%,P〈0.05];physical fatigue,mental fatigue were significantly higher than those in healthy control group[（7.25±1.93） points vs.（5.10 ± 1.87）points,（5.87 ±0.29） points vs.（3.53 ±0.68） points,P〈0.05].In OSAHS patients,mild subgroup NP level moderate mild group severe subgroup respectively[（11.23 ± 1.82） ng/ml （13.35 ±1.87） ng/ml （15.50 ±1.86） ng/ml,F =6.058,P =0.016].Correlation analysis suggested that the serum NP level was positively correlated with BMI,AHI,Tmax,LSaO_2,physical fatigue and mental fatigue（r =0.383,r =0.207,r =0.247,r =0.289,r =0.507,r =0.533,P〈0.05）.ESS score and AHI,Tmax,LSaO_2,physical fatigue score and mental fatigue had certain positive correlation（r =0.255,r =0.435,r =0.380,r = 0.322,r =0.385,P〈0.05）;ROC curve analysis suggest that serum NP predictive diagnosis of OSAHS patients,the AUC was 0.798,the value of cutoff was 6.9 ng/ml,the sensitivity was 84.4%,the specificity was 86.1%.Conclusion The reference index of serum neopterin could be used to evaluate the severity of OSAHS exacerbation and fatigue.