阻塞性睡眠呼吸暂停低通气综合征患者血清Nesfatin-1和Vaspin与病情严重程度及炎性反应的关系

Relationships of serum Nesfatin-1 and Vaspin with severity and inflammatory response in patients with obstructive sleep apnoea hypopnoea syndrome

目的 观察不同程度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血清Nesfatin-1、Vaspin水平变化,探讨其与OSAHS严重程度及炎性反应的关系。方法 2021年12月—2022年4月山西医科大学第一医院行多导睡眠监测者88例,记录呼吸暂停低通气指数(AHI)、最低血氧饱和度(LSpO_(2))、氧减饱和度指数(ODI)、血氧饱和度<90%时间占总监测时间的百分比(T90%)。依据AHI进行OSAHS分级,32例重度OSAHS者为重度组,37例轻中度OSAHS者为轻中度组,19例OSAHS分级正常者为正常组。采集3组空腹肘静脉血,采用ELISA法测定血清Nesfatin-1、Vaspin、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平。比较3组性别、年龄、病史、颈围、体质量指数(BMI)、肥胖(BMI≥30 kg/m^(2))比率等临床资料;Pearson相关法分析血清Nesfatin-1、Vaspin与AHI、TNF-α、IL-6的相关性。结果 (1)重度组BMI[(29.16±3.48)kg/m^(2)]、颈围[(41.39±3.09)cm]、AHI[55.65(44.10,74.80)次/h]、ODI[55.60(42.80,70.20)次/h]、T90%[35.55(11.30,58.30)%]、肥胖比率(40.6%)及血清Nesfatin-1[(2 643.77±565.77)ng/L]、TNF-α[(65.81±7.92)ng/L]、IL-6[(40.85±6.22)ng/L]水平均高于轻中度组[(26.83±3.63)kg/m^(2)、(38.26±4.20)cm、14.80(9.50,23.30)次/h、16.70(12.70,25.30)次/h、1.00(0.30,4.80)%、18.9%、(2 339.60±517.80)ng/L、(57.90±9.99)ng/L、(36.44±5.65)ng/L]和正常组[(22.81±3.24)kg/m^(2)、(33.74±2.80)cm、1.60(0.90,2.90)次/h、2.00(1.20,3.70)次/h、0、5.3%、(1 717.15±450.57)ng/L、(44.99±5.84)ng/L、(31.63±4.29)ng/L](P<0.05),轻中度组均高于正常组(P<0.05);重度组LSpO_(2)[69.50(59.30,78.50)%]、血清Vaspin水平[(9.68±2.64)μg/L]均低于轻中度组[83.00(77.00,87.00)%、(11.34±2.7)μg/L]和正常组[92.00(91.00,93.00)%、(13.13±2.35)μg/L](P<0.05),轻中度组均低于正常组(P<0.05)。3组性别比例、年龄、吸烟史、饮酒史、脑梗死史、合并高血压及心脏病比率比较差异均无统计学意义(P>0.05)。(2)Nesfatin-1与AHI、TNF-α、IL-6均呈正相关(r=0.272,P=0.024;r=0.307,P=0.010;r=0.438,P<0.001),Vaspin与AHI、TNF-α、IL-6均呈负相关(r=-0.375,P=0.002;r=-0.291,P=0.015;r=-0.357,P=0.003)。结论 OSAHS患者随病情严重程度增加全身炎性反应加重、血清Nesfatin-1水平增高、血清Vaspin水平下降,Nesfatin-1和Vaspin可能参与OSAHS的发病和进展。

Objective To observe the changes of serum Nesfatin-l and Vaspin levels in patients with different degrees of obstructive sleep apnoea hypopnoea syndrome(OSAHS)and to explore their relationships with the severity of OSAHS and inflammatory response.Methods Eighty-eight patients with OSAHS underwent polysomnography in the First Hospital of Shanxi Medical University from December 2021 to April 2022 to record apnoea hypopnoea index(AHI),lowest oxygen saturation(LSpO_(2)),oxygen desaturation index(ODI),and percentage of cumulative time with oxygen saturation below 90%in total sleep time(T90%).According to AHI,88 patients were divided into severe OSAHS group(n=32),mild-to-moderate OSAHS group(n=37),and normal group(n=19).The fasting elbow venous blood was collected from three groups to detect the serum levels of Nesfatin-l,Vaspin,tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)by ELISA.The gender,age,medical history,neck circumference,height,body mass index(BMI),and rate of obesity(BMI≥30 kg/m^(2))were compared among three groups.Pearson correlation analysis was done to analyze the correlations of serum Nesfatin-1 and Vaspin with AHI,TNF-αand IL-6.Results(1)The BMI,neck circumference,AHI,ODI,T90%,obesity rate,and serum levels of Nesfatin-1,TNF-αand IL-6 were higher in severe OSAHSgroup[(29.16±3.48)kg/m^(2),(41.39±3.09)cm,55.65(44.10,74.80)times/h,55.60(42.80,70.20)times/h,35.55(11.30,58.30)%,40.6%,(2643.77±565.77)ng/L,(65.81±7.92)ng/L,(40.85±6.22)ng/L]than those in mild-to-moderateOSAHSgroup[(26.83±3.63)kg/m^(2),(38.26±4.20)cm,14.80(9.50,23.30)times/h,16.70(12.70,25.30)times/h,1.00(0.30,4.80)%,18.9%,(2339.60±517.80)ng/L,(57.90±9.99)ng/L,(36.44±5.65)ng/L]and normal group[(22.81±3.24)kg/m^(2),(33.74±2.80)cm,1.60(0.90,2.90)times/h,2.00(1.20,3.70)times/h,0,5.3%,(1717.15±450.57)ng/L,(44.99±5.84)ng/L,(31.63±4.29)ng/L](P<0.05),and higher in mild-to-moderate OSAHS group than those in normal group(P<0.05).The LSpO_(2) and serum Vaspin level were lower in severe OSAHS group[69.50(59.30,78.50)%,(9.68±2.64)μg/L]than those in mild-to-moderate OSAHS group[83.00(77.00,87.00)%,(11.34±2.70)μg/L]and normal group[92.00(91.00,93.00)%,(13.13±2.35)μg/L](P<0.05),and lower in mild-to-moderate OSAHS group than those in normal group(P<0.05).There were no significant differences in the gender ratio,age,smoking habits,alcohol consumptions,history of cerebral infarction,and percentages of hypertension and heart diseases among three groups(P>0.05).(2)Nesfatin-1 was positively correlated with AHI,TNF-αand IL-6(r=0.272,P=0.024;r=0.307,P=0.010;r=0.438,P<0.001),and Vaspin was negatively correlated with AHI,TNF-αand IL-6(r=-0.375,P=0.002;r=-0.291,P=0.015;r=-0.357,P=0.003).Conclusion With the development of the severity of disease,the systemic inflammatory response aggravates,the serum Nesfatin-1 level increases and the serum Vaspin level decreases in OSAHS patients,and both Nesfatin-l and Vaspin are involved in the occurrence and development of OSAHS.