无创正压通气对心力衰竭合并阻塞性睡眠呼吸暂停综合征患者红细胞生成素及N-末端脑钠肽前体水平的影响

Effects of Noninvasive Positive Pressure Ventilation on Erythropoietin and N-terminal Pro Brain Natriuretic Peptide Levels in Patients with Heart Failure Complicated with Obstructive Sleep Apnea Syndrome

目的探究无创正压通气(NPPV)对心力衰竭合并阻塞性睡眠呼吸暂停综合征(OSAHS)患者红细胞生成素(EPO)以及N-末端脑钠肽前体(NT-proBNP)水平的影响,为NPPV对心力衰竭合并OSAHS的治疗提供理论依据。方法研究对象为2013年5月—2016年5月期间于荆州市第三人民医院治疗的50例中重度心力衰竭合并OSAHS患者和50例体检正常患者,将50例中重度心力衰竭合并OSAHS患者设为OSAHS组,50例体检正常患者设为对照组。治疗前后检测患者EPO、血红蛋白(Hb)、红细胞计数(RBC)、平均红细胞蛋白含量(MCH)、红细胞比积(HCT)、平均红细胞体积(MCV)、NT-proBNP水平、中心收缩压、中心舒张压、夜间平均最低血氧饱和度(LSaO_2)以及睡眠呼吸暂停低通气指数(AHI)。结果 OSAHS患者治疗前后EPO、Hb、RBC、MCH、HCT、MCV均高于对照组(P<0.05);OSAHS患者治疗后EPO、Hb、RBC、MCH、HCT、MCV均低于治疗前(P<0.05);OSAHS患者治疗前后NT-proBNP水平、中心收缩压、中心舒张压均高于对照组(P<0.05);OSAHS患者治疗后NT-proBNP水平、中心收缩压、中心舒张压均低于治疗前(P<0.05);OSAHS患者治疗前后LSaO_2、AHI均低于对照组(P<0.05);OSAHS患者治疗后LSaO_2、AHI均高于治疗前(P<0.05);NT-proBNP水平、EPO、中心收缩压、中心舒张压与AHI呈正相关(r=0.547、r=0.864、r=0.487、r=0.657,P<0.05);NT-proBNP水平、EPO、中心收缩压、中心舒张压与LSaO_2呈负相关(r=-0.574、r=-0.693、r=-0.754、r=-0.583,P<0.05)。结论 NPPV能够显著改善心力衰竭合并OSAHS患者NT-proBNP水平及EPO,同时显著改善LSaO_2及AHI,改善睡眠质量,降低器官损害,保证患者良好的预后效果。

Objective To explore effect of noninvasive positive pressure ventilation( NPPV) on erythropoietin( EPO)and N-terminal pro brain natriuretic peptide levels( NT-proBNP) in patients with heart failure complicated with obstructive sleep apnea syndrome( OSAHS),and to provide a theoretical basis for treatment of heart failure combined with OSAHS by NPPV. Methods The study object was 50 cases of severe heart failure patients with OSAHS and 50 cases of healthy patients during May 2013-May 2016 in Jingzhou Third People's Hospital,50 cases of severe heart failure patients with OSAHS were set as the OSAHS group,50 cases of healthy patients with physical examination were set as the control group. Before and after treatment,EPO,hemoglobin( Hb), red blood cell count( RBC), mean corpuscular protein content( MCH), hematocrit( HCT),mean corpuscular volume( MCV),NT-proBNP level,central systolic pressure,central diastolic pressure,nighttime average minimum blood oxygen saturation( LSaO_2) and sleep apnea hypopnea index( AHI) were detected. Results The OSAHS group's preoperative and postoperative EPO,Hb,RBC,MCH,HCT,MCV were higher than those of the control group( P < 0. 05); The OSAHS group's postoperative EPO,Hb,RBC,MCH,HCT,MCV were lower than those before treatment( P < 0. 05); the OSAHS group' s preoperative and postoperative level of NT-proBNP,central systolic pressure,central diastolic pressure were higher than those of the control group( P < 0. 05); the OSAHS group' s postoperative level of NT-proBNP,central systolic pressure,central diastolic pressure were lower than those before treatment( P < 0. 05); the OSAHS group's preoperative and postoperative LSaO_2,AHI were lower than those of the control group( P < 0. 05); the OSAHS group's postoperative LSaO_2 and AHI were higher than those before treatment( P < 0. 05); the level of NT-proBNP,EPO,central systolic pressure,central diastolic pressure were positively correlated with AHI( r = 0. 547,r = 0. 864,r = 0. 487,r = 0. 657,P < 0. 05); the level of NT-proBNP,EPO,central systolic pressure,central diastolic pressure were negatively correlated with LSaO_2( r =-0. 574,r =-0. 693,r =-0. 754,r =-0. 583,P < 0. 05). Conclusion NPPV can significantly improve the level of NT-proBNP and EPO in heart failure patients with OSAHS,and evidently improve LSaO_2 and AHI,enhance the quality of sleep,reduce organ damage,and ensure the good prognosis.