阻塞性睡眠呼吸暂停低通气综合征对心肌梗死患者炎性因子、血管内皮功能及左心室功能的影响研究

Impact of OSAHS on Inflammatory Cytokines,Vascular Endothelial Function and Left Ventricular Function of Patients With Myocardial Infarction

目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)对心肌梗死患者炎性因子、血管内皮功能及左心室功能的影响。方法选取2012年11月—2014年11月三门峡黄河医院心内科收治的心肌梗死患者82例,其中合并OSAHS患者39例(OSAHS组),未合并OSAHS患者43例(非OSAHS组),另选取同期体检健康者40例作为对照组。比较3组受试者多导睡眠监测(PSG)结果〔最低血氧饱和度(LSaO_2)和呼吸暂停低通气指数(AHI)〕、血清炎性因子〔超敏C反应蛋白(hs-CRP)、白介素6(IL-6)、肿瘤坏死因子α(TNF-α)〕水平、血管内皮功能指标〔内皮素1(ET-1)、一氧化氮(NO)〕、血清同型半胱氨酸(Hcy)水平及左心室功能指标〔左心室射血分数(LVEF)、左心室短轴缩短率(LVFS)〕。结果 OSAHS组患者LSaO_2低于非OSAHS组和对照组,AHI高于非OSAHS组和对照组(P<0.05);非OSAHS组患者LSaO_2低于对照组,AHI高于对照组(P<0.05)。OSAHS组患者血清hs-CRP、IL-6、TNF-α水平高于非OSAHS组和对照组,非OSAHS组患者血清hs-CRP、IL-6、TNF-α水平高于对照组(P<0.05)。OSAHS组患者血清ET-1、Hcy水平高于非OSAHS组和对照组,血清NO水平低于非OSAHS组和对照组(P<0.05);非OSAHS组患者血清ET-1、Hcy水平高于对照组,血清NO水平低于对照组(P<0.05)。OSAHS组患者LVEF、LVFS低于非OSAHS组和对照组,非OSAHS组患者LVEF、LVFS低于对照组(P<0.05)。结论合并OSAHS的心肌梗死患者炎性因子水平明显升高,血管内皮功能和左心室功能受损程度较重。

Objective To investigate the impact of OSAHS on inflammatory cytokines,vascular endothelial function and left ventricular function of patients with myocardial infarction. Methods From November 2012 to November 2014 in the Department of Cardiology, the Yellow River Hospital of Sanmenxia, a total of 82 patients with myocardial infarction were selected,thereinto 39 cases with OSAHS were selected as A group,other 43 cases without OSAHS were selected as B group; a total of 40 healthy cases admitted to this hospital for physical examination were selected as control group. PSG results( including LSaO_2 and AHI), inflammatory cytokines( including hs-CRP, IL-6 and TNF-α), index of vascular endothelial function( including ET-1 and NO),serum Hcy level and index of left ventricular function( including LVEF and LVFS) were compared among the three groups. Results LSaO_2 of A group was statistically significantly lower than that of B group and control group,respectively,while AHI of A group was statistically significantly higher than that of B group and control group,respectively( P< 0. 05); LSaO_2 of B group was statistically significantly lower than that of control group,while AHI of B group was statistically significantly higher than that of control group( P < 0. 05). Serum levels of hs-CRP, IL-6 and TNF-α of A group were statistically significantly higher than those of B group and control group,those of B group were statistically significantly higher than those of control group( P < 0. 05). Serum levels of ET-1 and Hcy of A group was statistically significantly higher than those of B group and control group,while serum NO level of A group was statistically significantly lower than that of B group and control group,respectively( P < 0. 05); serum levels of ET-1 and Hcy of B group were statistically significantly higher than those of control group,while serum NO level of B group was statistically significantly lower than that of control group( P < 0. 05). LVEF and LVFS of A group were statistically significantly lower than those of B group and control group, those of B group were statistically significantly lower than those of control group( P < 0. 05). Conclusion Of myocardial infarction patients with OSAHS,the serum inflammatory cytokines levels are significantly elevated,the extent of damage of vascular endothelial function and left ventricular function are more severe.