摘要
目的探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患儿血清食欲素A（Orexin-A）水平在诊断儿童OSAHS中的诊断价值。方法因睡眠打鼾就诊的门诊及住院患儿60例，以多导睡眠监测仪检测结果作为金标准，将患儿分为OSAHS组（40例）和对照组（20例）。采用竞争酶联免疫分析法，测定血清Orexin-A水平，与金标准进行比较。对血清Orefin-A作分层检测，得出各层的阳性似然比。分析OSAHS组Orefin．A水平与呼吸暂停低通气指数、微觉醒指数、最低血氧饱和度的相关性。结果OSAHS组Orefin-A水平为（0．49±0．10）μg／L，对照组患儿为（0．28±0．11）μg／L（P〈0．01）。当患儿Orefin．A水平高于0．36μg／L，则患有OSAHS的可能性增加，其灵敏度为85．0％，特异度为80．0％，符合率（一致率）为83．33％。且Orefin-A水平与呼吸暂停低通气指数、微觉醒指数呈正相关（r=0．427、0．468，P均〈0．05），与最低血氧饱和度、平均血氧饱和度呈负相关（r=-0．527、-0．541，P均〈0．01），与体块指数无相关性（r=-0．212，P〉0．05）。OSAHS患儿扁桃体及腺样体切除术后3个月血清Orexin-A水平明显低于术前（t=4．36，P〈0．05）。结论食欲素-A可以作为一种初步筛查可疑OSAHS患儿并且可以作为判断OSAHS病情严重程度及治疗反应的血清学指标。
Objective Currently people regard polysomnography （PSG） monitoring as the golden standard for diagnosis of obstructive sleep apnea-hypopnea syndrome （OSAHS） in children. However, due to the high cost, time and manpower consuming, PSG is not applicable to epidemiological investigation and clinical screening, especially not suitable for child patients and remote hospitals in Xinjiang. Therefore, it is of important clinical significance to find out a simple method （ e. g. a kind of serum index） to primarily screen out suspicious patients for early diagnosis and treatment. The present study was conducted to assess the clinical usefulness of the measurement of orexin-A concentration in serum as a diagnostic predictor to screen patients with OSAHS in children. Methods Serum orexin-A concentration was measured with enzyme immunoassay （EIA） kit in 60 patient with snoring before performing polysomnography （PSG）. Subsequently all the subjects underwent PSG test. Forty subjects were diagnosed as having OSAHS, and twenty subjects had no OSAHS. These 20 non-OSAHS subjects served as controls. Compared with the PSG results the clinical usefulness of the measurement of orexin-A concentration in serum was assessed as a diagnostic predictor to screen patients with OSAHS. Correlation between orexin-A levels and apnea hypoventilation index （ AHI）, micro-arousal index （MAI） and lowest SaO2 （ LSaO2 ） were analyzed. Results The serum orexin-A levels in the OSAHS group [ （0. 49±0. 10） μg/L] was significantly higher than that of the control group [ （0. 28±0. 11 ）μg/L, P 〈0. 01 ]. If a patient＇s level of orexin-A was higher than 0. 36 μg/L, the patient more likely to have OSAHS. The sensitivity rate was 85. 0% and the specificity was 80. 0%. Serum orexin-A levels in children with OSAHS correlated positively with the AHI （ r = 0. 427, P 〈 0. 05 ） and MAI （r= 0.468, P〈0.05）, but correlated negatively with the I-SaO2 （r = -0.527, P 〈0.01） and the mean oxygen saturation （ MS
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2008年第4期291-296,共6页
Chinese Journal of Pediatrics
