成人OSA患者血浆脂肪因子ANGPTL-4、CTRP-3、DPP4、FGF-21的表达及意义

Expression and significance of Plasma adipokines ANGPTL-4,CTRP-3, DPP4 and FGF-21 in adult OSA patients

目的:通过比较不同程度的阻塞型睡眠呼吸暂停(OSA)患者睡眠前后血浆脂肪因子人血管生成素样蛋白4(ANGPTL-4)、C1q肿瘤坏死因子相关蛋白3(CTRP-3)、二肽基肽酶IV(DPP4)、人成纤维生长因子-21(FGF-21)的表达水平,了解其与OSA严重程度的关系,探寻OSA的发病机制。方法:依就诊时间自2017年1月至2020年12月纳入就诊于南京医科大学附属脑科医院胸科院区及昆山市第一人民医院的成年鼾症患者共200例,经多导睡眠监测(PSG)后根据呼吸暂停低通气指数(AHI)分为单纯鼾症组、轻度OSA组、中度OSA组、重度OSA组,每组各50例,测定各组患者入睡前及醒后的血浆ANGPTL-4、CTRP-3、DPP4和FGF-21的水平,并与OSA的病情严重程度进行相关性分析。结果:和单纯鼾症组比较,OSA患者睡前及醒后CTRP-3水平降低(P<0.05),ANGPTL-4、DPP-4、FGF-21水平升高(P<0.05)。OSA患者睡前及醒后的ANGPTL-4、DPP4、FGF-21与体质量指数(BMI)、颈围、AHI呈正相关(P<0.05),与最低血氧饱和度(SpO2)、平均SpO2呈负相关(P<0.05);而CTRP-3则刚好相反。各组患者睡前和醒后4种脂肪因子水平比较,差异无统计学意义(P>0.05)。结论:脂肪因子CTRP-3的水平随OSA的病情的加重而降低,ANGPTL-4、DPP4、FGF-21水平随OSA的病情的加重而升高,但在睡眠前后未发现节律变化。

Objective: To investigate the levels of plasma adipokines angiopoietin-like 4(ANGPTL-4), complement-C1 q/tumor necrosis factor-related protein 3(CTRP-3), dipeptidyl peptidase 4(DDP4) and fibroblast growth factors 21(FGF-21) levels and their relationships with the severity of obstructive sleep apnea(OSA), and explore the pathogenesis of OSA. Methods: Adult patients in Chest District of Nanjing Brain Hospital and Kunshan First People’s Hospital were enrolled from January 2017 by order of visits. After polysomnographic monitoring(PSG), all the patients was divided into simple snoring group, mild OSA, moderate OSA, severe OSA group(n=50,respectively) according to apnea-hypopnea index(AHI). Plasma ANGPTL-4, CTRP-3, DDP-4 and FGF-21 levels were compared and analyzed the correlation with the severity of OSA. Results: Plasma ANGPTL-4, DPP4 and FGF-21 levels in OSA groups were increased compared with the simple snoring group while CTRP-3 decreased(P<0.05). Whether before sleep or after awakening, plasma ANGPTL-4, DDP4 and FGF-21 levels in OSA patients were positively associated with body mass index(BMI), neck circumference and AHI, but negatively with lowest pulse oxygen saturation(SpO2) and mean SpO2(P<0.05),while The results of CTRP-3 were just the opposite. Whether before or after PSG, the levels of plasma ANGPTL-4, CTRP-3, DPP4 and FGF-21 in each group showed no statistical difference(P>0.05). Conclusion: The levels of adipokines CTRP-3 decreased with the aggravation of OSA, while ANGPTL-4, DPP4 and FGF-21 showed the opposite results, but no rhythm changes in these four adipokines before sleep or after awakening.