肥胖儿童发生OSAHS的促炎和抗炎免疫调节失衡机制探讨

An investigation of mechanism for pro-inflammatory and anti-inflammatory immune regulation imbalance in obese children with OSAHS

目的探讨肥胖儿童发生阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的促炎和抗炎免疫调节失衡机制。方法选取90例肥胖儿童,通过多导睡眠图睡眠监测,共确诊42例肥胖儿童合并OSAHS(肥胖OSAHS组),48例未合并OSAHS(肥胖非OSAHS组),另选取50例非肥胖健康儿童作为健康对照组。采用流式细胞术检测三组外周血T淋巴细胞亚群表达水平,ELISA法检测三组血清IFN-γ、IL-4和IL-10的表达水平。结果肥胖OSAHS组的行为表现、既往过敏性鼻炎史、父或母肥胖史、父或母打鼾史和睡眠相关症状发生率高于肥胖非OSAHS组和健康对照组(P<0.05)。与肥胖非OSAHS组和健康对照组比较,肥胖OSAHS组总睡眠时间、睡眠效率、最低血氧饱和度、深睡眠期占睡眠时间比和快动眼睡眠期占睡眠时间比降低(P<0.01),而浅睡眠期占睡眠时间比、阻塞性呼吸暂停指数、睡眠呼吸紊乱指数和微觉醒指数增高(P<0.01)。与肥胖非OSAHS组和健康对照组比较,肥胖OSAHS组外周血中CD4+T淋巴细胞占比、IFN-γ和IL-4增高(P<0.01),自然杀伤T细胞占比和IL-10降低(P<0.01)。结论肥胖儿童发生OSAHS存在促炎和抗炎反应免疫失衡,IL-10抗炎的减弱可能是导致肥胖儿童发生OSAHS的重要原因。

Objective To investigate the mechanism for pro-inflammatory and anti-inflammatory immune regulation imbalance in obese children with obstructive sleep apnea hypopnea syndrome(OSAHS).Methods With sleep polysomnography monitoring,42 obese children were diagnosed as OSAHS(group A)and 48 obese children without OSAHS(group B).Another 50 non-obese healthy children were selected as group C.Flow cytometry was used to detect the expression of peripheral blood T lymphocyte subsets and ELISA method was used to detect the levels of IFN-γ,IL-4 and IL-10 in three groups.Results The incidences in behavioral performance,allergic rhinitis,history of father or mother obesity,history of father or mother snoring and sleep-related symptoms in group A were higher than those in groups of B and C(P<0.05).Compared with groups of B and C,the total sleep time,sleep efficiency,minimum blood oxygen saturation,ratio of deep sleep period to sleep time and ratio of rapid eye movement sleep period to sleep time were decreased(P<0.01),while the ratio of light sleep period to sleep time,obstructive apnea index,sleep disordered breathing index and arousal index were increased in group A(P<0.01).Compared with groups of B and C,the proportion of CD4^+T lymphocytes,IFN-γand IL-4 in the peripheral blood were increased(P<0.01),and the proportions of natural killer T cells and IL-10 were decreased in group A(P<0.01).Conclusion The immune imbalance of pro-inflammatory and anti-inflammatory reaction happens in obese children with OSAHS.The reduction of IL-10 anti-inflammation may be an important factor for OSAHS occurrence in obese children.