氧化应激在阻塞性睡眠呼吸暂停低通气综合征影响脑小血管病认知障碍中的作用

Role of oxidative stress in OSAHS affecting cognitive impairment in cerebral small vessel disease patients

目的探讨氧化应激在阻塞性睡眠呼吸暂停低通气综合征(OSAHS)影响脑小血管病认知障碍中的作用。方法前瞻性选取2019年4月~2020年1月长沙市第一医院神经内科收治的脑小血管病患者80例,根据认知情况分为认知障碍组42例,认知正常组38例。根据诊断又分为OSAHS组69例,非OSAHS组11例。OSAHS组根据呼吸暂停低通气指数(apnea hypopnea index,AHI)严重程度分为轻度组27例(5≤AHI<15),中度组27例(15≤AHI<30),重度组15例(AHI≥30)。检测AHI、晚期氧化蛋白产物(advanced oxidation protein products,AOPP)和总抗氧化能力(total antioxidant capacity,T-AOC)。应用简易智能状态检查量表(MMSE)评估认知功能。并进行脑小血管病伴OSAHS患者AHI与AOPP、T-AOC、MMSE评分的相关性分析。结果认知障碍组与认知正常组T-AOC水平比较,差异无统计学意义(P>0.05)。认知障碍组AHI、AOPP水平明显高于认知正常组,差异有统计学意义(P<0.01)。OSAHS组AOPP水平明显高于非OSAHS组,差异有统计学意义(P<0.01)。中度组和重度组AOPP水平明显高于轻度组,MMSE评分明显低于轻度组,差异有统计学意义(P<0.05)。重度组AOPP水平明显高于中度组,MMSE评分明显低于中度组,差异有统计学意义(P<0.05)。Spearman相关分析显示,脑小血管病伴OSAHS患者AOPP水平与AHI呈正相关(r=0.731,P=0.001),MMSE评分与AHI呈负相关(r=-0.789,P=0.001),T-AOC水平与AHI不相关(r=-0.189,P=0.120)。结论氧化应激过程可能参与OSAHS影响脑小血管病认知障碍的发病机制。

Objective To study the role of oxidative stress in OSAHS affecting cognitive impairment in cerebral small vessel disease(CSVD)patients.Methods Eighty CSVD patients admitted to our hospital from April 2019 to January 2020 were divided into cognitive impairment group(n=42)and normal cognitive function group(n=38)or OSAHS group(n=69)and OSAHS-free group(n=11).The patients in OSAHS group were further divided into mild OSAHS group or 5≤apnea hypopnea index(AHI)<15 group(n=27),moderate OSAHS group or 15≤AHI<30 group(n=27)and severe OSAHS group or AHI≥30 group(n=15).The AHI,advanced oxidized protein products(AOPP)and total antioxidant capacity(T-AOC)were detected in different groups.The cognitive function of CSVD patients was assessed according to their simple MMSE scale score.The relationship of AHI with AOPP,T-AOC and MMSE scale score in CSVD patients with OSAHS was analyzed.Results No significant difference was detected in T-AOC between cognitive impairment group and normal cognitive function group(P>0.05).The AHI and serum level of AOPP were significantly higher in cognitive impairment group than in normal cognitive function group(P<0.01)and in OSAHS group than in OSAHS-free group(P<0.01).The serum level of AOPP was significantly higher while the MMSE scale score was significantly lower in moderate and severe OSAHS groups than in mild OSAHS group(P<0.05)and in severe OSAHS group than in moderate OSAHS group(P<0.05).Spearman correlation analysis showed that the serum level of AOPP was positively related with the AHI while the MMSE scale score was negatively related with the AHI and the T-AOC was not related with the AHI in CSVD patients with OSAHS(r=0.731,P=0.001;r=-0.789,P=0.001;r=-0.189,P=0.120).Conclusion Oxidative stress may be involved in the pathogenesis of OSAHS affecting cognitive impairment in CSVD patients.