葡萄籽原花青素对中老年OSAHS患者肺通气及炎症水平的影响

Effects of grape seed proanthocyandin extract on pulmonary ventilation and inflammationin elderly patients with obstructive sleep apnea-hypopnea syndrome

目的观察葡萄籽原花青素(grape seed proanthocyanidin extract,GSPE)对中老年阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)患者肺通气及炎症水平的影响。方法 2012年12月-2014年12月为华北理工大学附属医院呼吸内科确诊的108例中老年OSAHS患者随机分为对照组(36例),GSPE A组(36例)与GSPE B(36例)。对照组给予持续气道正压通气(CPAP)治疗;GSPE A组和GSPE B组在此基础上分别给予高剂量(100mg/粒,2粒/次)和低剂量(100 mg/粒,1粒/次)GSPE口服治疗。在治疗前和治疗后8周检测外周血白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平,结合多导睡眠图监测(polysonmography,PSG)监测最长低通气时间(the maximum hypopnea time,MHT)、低通气指数(low ventilation index,HI)、最长呼吸暂停时间(the longest apnea time,LAT)、呼吸暂停指数(apnea index,AI)和呼吸紊乱指数(respiratory disturbance index,RDI)、夜间最低血氧饱和度(lowest oxygen saturation,LSa O_2)。采用SPSS17.0软件进行统计分析。结果治疗前,三组基本临床资料、PSG检测指标、血清IL-6、TNF-α水平差异无统计学意义(P>0.05);与治疗前比较,对照组治疗后的MHT、HI、LAT、AI和RDI、LSa O_2均显著改善,差异有统计学意义(P<0.05);GSPE A组:治疗后的MHT、HI、LAT、AI、RDI、LSa O_2较治疗前显著改善,差异有统计学意义(P<0.05);GSPE B组:治疗后的MHT、HI、RDI、LSa O_2均较治疗前显著改善,差异有统计学意义(P<0.05)。LAT、AI虽有所改善,但差异无统计学意义(P>0.05);治疗后,GSPE A组和GSPE B组的MHT、HI、LAT、AI、RDI和LSa O_2的改善程度优于对照组,差异有统计学意义(P<0.05);GSPE A组MHT、HI、LAT、AI、RDI和LSa O_2的改善程度优于对照组GSPE B组,差异有统计学意义(P<0.05);治疗后,GSPE A组和GSPE B组中IL-6(20.10±5.96和26.33±6.38 vs.33.14±7.22)、TNF-α(32.42±6.33和42.80±5.48 vs.51.32±4.28)低于对照组,差异有统计学意义(P<0.05);GSPE A组治疗总有效率(88.2%)显著高于对照组(70.5%)和GSPE B组(81.8%),差异有统计学意义(P<0.05)。结论 GSPE可有效的降低IL-6、TNF-α水平,提高中老年OSAHS患者的治疗效果。

Objective To observe the effects of grape seed proanthocyandin extract（ GSPE） on pulmonary ventilation and inflammation in elderly patients with obstructive sleep spnea-hypopnea syndrome（ OSAHS）. Methods From December 2012 to December 2014,108 cases of OSAHS in Department of Respirology,Affiliated Hospital of North China University of Science Technology were divided into three groups： control group（ 36 cases）,GSPE A group（ 36 cases） and GSPE B group（ 36 cases）. The control group received continuous positive airways pressure（ CPAP） treatment,while GSPE group A and GSPE group B respectively received high（ 100 mg / capsule,2 capsules / time） and low（ 100 mg / capsule,1 capsule / time） doses of GSPE treatment orally besides CPAP. Before treatment and 8 weeks after treatment,peripheral blood interleukin 6（ IL-6）,tumor necrosis factor-α（ TNF-α） were deteceted,and the maximum hypopnea time（ MHT）,low ventilation index（ HI）,the longest apnea time（ LAT）,apnea index（ AI） and respiratory disturbance index（ RDI）,lowest oxygen saturation（ LSa O_2） were monitored by polysonmography（ PSG）. The data were statistically analyzed with SPSS17. 0 software. Results Before the treatment,there were no significant differences in basic clinical data,PSG monitoring indexes,IL-6 and TNF-a levels among the patients of three groups（ 〉P0. 05）.Compared with those before treatment,the MHT,HI,LAT,AI,RDI and LSa O_2 in the control group and GSPE group A were significantly improved after treatment（ P〈0. 05）,so were the MHT,HI,RDI and LSa O_2 in GSPE group B（ P〈 0. 05. After treatment,the MHT,HI,RDI and LSa O_2 in GSPE group A and GSPE group B were more improved when compared with the control group（ P〈0. 05）. So were for GSPE group A when compared with GSPE group B（ P〈0. 05）. After treatment,the IL-6 and TNF-a levels in GSPE group A and GSPE group B were significantly lower than in the control group（ IL-6： 20. 10±5. 96 and 26. 33±6. 38 vs. 33. 14±7. 22; TNF-a ： 32. 42±6. 33 and 42. 80±5. 48 vs. 51. 32±4. 28）（ P〈0. 05）. The effective rate of treatment in GSPE group A（ 88. 2%） was higher than those in GSPE group B（ 81. 8%） and control group（ 70. 5%）（ P〈0. 05）. Conclusions Grape seed proanthocyandin extract can effectively reduce IL-6 and TNF-α levels and promote the clinical treatment effects in elderly patients with obstructive sleep apnea-hypopnea syndrome.