阻塞性睡眠呼吸暂停综合征患者血炎症因子水平与动脉粥样硬化相关性及干预治疗的研究

Association between plasma inflammatory factors levels and atherosclerosis in patients with obstructive sleep apnea syndrome

目的探讨阻塞性睡眠呼吸暂停综合征(OSAS)患者血炎症因子与动脉粥样硬化的关系。方法选取就诊的OSAS患者60例,分为轻度组20例,中度组20例,重度组20例,另选对照组20例。对其中OSAS组中40例中重度患者进行持续气道正压通气(CPAP)治疗,并检测治疗前后颈动脉内中膜厚度(IMT)、肱—踝脉搏波传导速度(ba PWV)以及血炎症因子(IL-18、TNF-α、hs-CRP、ICAM-1、VCAM-1、E选择素和P选择素)水平的差异作统计学处理。结果 OSAS组的血炎症因子水平明显高于对照组,且OSAS各组间均有明显差异(均P<0.05)。血炎症因子水平与颈动脉IMT、呼吸暂停低通气指数(AHI)、ba PWV呈正相关(P<0.01),与最低脉搏氧饱和度(Sp O2)呈负相关(P<0.01)。CPAP治疗后OSAS患者血炎症因子水平、IMT以及ba PWV均有下降。结论 OSAS患者颈动脉IMT增厚、ba PWV增快与血炎症因子水平增高显著相关。血炎症因子水平升高与OSAS严重程度相关,动脉粥样硬化的进展可能与OSAS相关的炎症反应有关。CPAP治疗能够改善患者AHI以及Sp O2,降低血炎症因子水平。

Objective To investigate the association between plasma inflammatory factors levels and atherosclerosis in patients with obstructive sleep apnea syndrome(OSAS). Methods Based on apnea hypopnea index(AHI) during sleep monitored by polysomnography, 60 patients with OSAS were recruited and divided into a mild OSAS group(n=20), a moderate group(n=20), and a severe group(n=20).Twenty health subjects were selected as the control group. Fourty patients with moderate- to- severe OSAS underwent continuous positive airway pressure(CPAP) treatment. The color Doppler ultrasound was used to measure intima-media thickness(IMT) of the jugular arteries. Plasma inflammatory factors levels were measured by ELISA. Brachial-ankle pulse wave velocity(ba PWV) were assessed non-invasively using a VP1000 automated PWV analyzer. Results Compared with the plasma inflammatory factors levels in the control group, there was a significant increase in the OSAS group. Moreover, there was a significant difference increase in the mild OSAS group, moderate group, and severe OSAS group. The plasma inflammatory factors levels were positively correlated with jugular arterial IMT, AHI and ba PWV and negatively correlated with Sp O2. Plasma inflammatory factors levels, IMT and ba PWV were significantly decreased after CPAP treatment. Conclusion Jugular arterial IMT, ba PWV and plasma inflammatory factors levels were significantly increased and closely correlated. The plasma inflammatory factors levels were correlated with the severity of OSAS. CPAP treatment can improve AHI and Sp O2 and reduce the level of serum inflammatory factors.