妊娠合并阻塞性睡眠呼吸暂停低通气综合征患者血清YKL-40、内脂素临床价值

The clinical value of serum YKL40 and visfatin levels of pregnant women with obstructive sleep apnea hypopnea syndrome

目的:观察妊娠合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血清YKL-40、内脂素水平变化的临床意义。方法:选择2017年7月—2018年7月威海市立医院妇产科收治的82例妊娠期合并OSAHS患者为研究对象(观察组),依据多导睡眠监测(PSG)结果将患者分为轻度OSAHS组(32例)、中度OSAHS组(32例)、重度OSAHS组(18例),选择同期该院60例产检正常孕妇为对照组。两组对象均进行PSG监测和血清人类软骨糖蛋白39(YKL-40)、内脂素检测,对比各组呼吸暂停低通气指数(AHI)、最低血氧饱和度(LSaO2)、平均血氧饱和度(SaO2)、血清YKL-40、内脂素水平差异。Pearson相关性分析血清YKL-40、内脂素水平与妊娠期合并OSAHS病情关系。曲线下面积(ROC)分析YKL-40、visfatin对妊娠期OSAHS发生的预测价值。结果:观察组中各亚组AHI高于对照组、LSaO2低于对照组(均P<0.05),SaO2与对照组无差异(P>0.05)。观察组中,随着OSAHS病情加重AHI增大、LSaO2降低(均P<0.05),YKL-40、内脂素水平升高且均高于对照组(P<0.05)。AHI、LSaO2均与YKL-40(r=0.619、0.435,P<0.05)、内脂素(r=0.537、0.402,P<0.05)呈正相关,SaO2与YKL-40、内脂素无关(r=0.064、0.038,P>0.05)。血清YKL-40、内脂素诊断妊娠期OSAHS AUC分别为0.830、0.719,灵敏度、特异度分别为86.3%、82.1%,82.2%、79.1%。结论:妊娠合并OSAHS患者血清YKL-40、内脂素水平明显升高,且与OSAHS病情程度密切相关,孕期监测该指标可为预防妊娠期OSAHS的发生提供临床依据。

Objective:To observe the clinical value of the changes of serum YKL 40 and visfatin levels of pregnant women with obstructive sleep apnea hypopnea syndrome(OSAHS).Methods:From July 2017 to July 2018,82 pregnant women with OSAHS admitted to Weihai municipal hospital of Shandong province were included in observation group,and 60 health pregnant women who had regular antenatal checkup were in control group.The women in observation group were also divided into mild OSAHS group(32 cases),middle OSAHS group(32 cases),and severe OSAHS group(18 cases)according to the results of polysomnography.All included pregnant women had undergone PSG monitoring,and their serum levels of YKL 40 and visfatin were detected.The apnea hypopnea index(AHI),minimum oxygen saturation(LSaO2),mean oxygen saturation(SaO2),serum YKL 40 level of pregnant women were compared among the different groups.Pearson correlation analysis was used to analyze the relationship between serum level of YKL 40 or visfatin and the severity of disease of pregnant women with OSAHS.ROC analysis was used to analyze the value of serum levels of YKL 40 and visfatin for predicting of OSAHS occurring during pregnancy.Results:The AHI of pregnant women in observation group was significant higher than that of pregnant women in control group(P<0.05),LSaO2 was significant lower than that of pregnant women in control group(P<0.05),but there was no significant different in SaO2 between observation group and control group(P>0.05).In pregnant women of observation group,AHI increased gradually with the severity of OSAHS(P<0.05),and LSaO2 decreased gradually with the severity of OSAHS(P<0.05).The changes of serum level of YKL 40 and visfatin of pregnant women in observation group were significant higher than those of pregnant women in control group(P<0.05).AHI and LSaO2 were positively correlated with serum level of YKL 40(r=0.619,0.435,P<0.05),and AHI and LSaO2 were positively correlated with serum level of visfatin(r=0.537,0.402,P<0.05),but SaO2 was no associated with serum level of YKL40 or visfatin(r=0.064,0.038,P>0.05).The area under the curve(AUC)of serum level of YKL40 and visfatin for diagnosing OSAHS of pregnant women was 0.830 and 0.719,respectively.The sensitivity of serum level of YKL40 and visfatin were 86.3%and 82.1%,respectively,and the specificity of serum level of YKL40 and visfatin were 82.2%and79.1%,respectively.Conclusion:The serum levels of YKL 40 and visfatin of pregnant women with OSAHS are significantly increased,and are closely related to the severity of OSAHS.Monitoring the levels of serum YKL 40 and visfatin during pregnancy can provide evidence for preventing the occurrence of OSAHS during pregnancy.