摘要
目的探讨OSAHS患者血清炎症因子检测的临床意义。方法OSAHS患者40例和正常对照30例,采用酶联免疫技术检测血清8-异前列烷(8-isoPG)、白三烯B4(LTB4)、TNF-α、IL-10水平,以全自动生化分析仪测定高敏C反应蛋白(Hs-CRP)的浓度,并与睡眠监测指标进行相关性分析。其中20例OSAHS患者分别经自动持续气道正压通气(Auto-CPAP)或悬雍垂软腭咽成形术(UPPP)治疗3个月后,复查睡眠呼吸监测和上述炎症因子。结果①OSAHS组睡眠后血清中8-isoPG、LTB4、TNF-α、IL-10和Hs-CRP分别为(36.59±14.89)ng/L、(14.75±6.25)μg/L、(1022.13±97.57)ng/L、(4.68±3.42)ng/L和(2.46±1.58)mg/L,正常对照组分别为(19.91±7.76)ng/L、(1.43±0.72)μg/L、(540.00±78.70)ng/L、(7.41±4.49)ng/L和(0.30±0.16)mg/L,两组比较差异均有统计学意义(P均<0.01)。②OSAHS组血清中8-isoPG、LTB4、TNF-α和Hs-CRP随病情严重度增高而升高,IL-10随病情严重度增高而降低(P均<0.05)。③OSAHS患者睡眠后血清中8-isoPG、LTB4、TNF-α、Hs-CRP与呼吸暂停低通气指数(AHI)呈正相关(r值分别为0.863,0.746,0.868和0.842,P均<0.01);与睡眠中最低血氧饱和度(LSpO2)呈负相关(r值分别为-0.623,-0.524,-0.618和-0.562,P均<0.01);与平均血氧饱和度(MSpO2)呈负相关(r值分别为-0.654,-0.573,-0.537和-0.589,P均<0.01);OSAHS患者睡眠后血清中IL-10与AHI呈负相关(r=-0.722,P<0.01),与睡眠中LSpO2呈正相关(r=0.564,P<0.01),与MSpO2呈正相关(r=0.505,P<0.01)。④20例OSAHS患者经治疗3个月后血清8-isoPG、LTB4、TNF-α及Hs-CRP均较治疗前下降,血清中IL-10比治疗前上升(P<0.01)。⑤OSAHS患者治疗后血清8-isoPG、IL-10与正常对照组比较无显著差异(P>0.05),血清LTB4、TNF-α和Hs-CRP比正常对照组水平高(P<0.01)。结论OSAHS患者存在夜间低氧后炎症反应及氧化应激增强,抗炎因子水平降低。炎症因子检测结合睡眠呼吸监测对判断OSAHS严重程度和治疗效果具有一定的临床意义。
Objective To investigate the changes of 8-isoprostane （8-isoPG）, leukotriene B4 （LTB4） ,TNF-α,IL-10 and hypersensitive C-reactive protein（Hs-CRP） in serum of patients with obstructive sleep apnea hypopnea syndrome （OSAHS）. Methods Forty OSAHS patients （20 cases underwent therapeutic Auto-CPAP or UPPP treatment for over three months） and 30 normal controls were included in the study. Serum 8-isoPG, LTB4, TNF-α and IL-10 were measured by ELISA. Hs-CRP was detected by automatic biochemistry analyzer. Results ①The serum levels of 8-isoPG, LTB4, TNF-α, Hs-CRP were significantly higher and IL-10 was considerably lower after sleep in 40 OSAHS patients [（36.59± 14.89）ng/L,（14.75±6.25） μg/L, （1022.13 ± 97.57） ng/L, （2.46 ±1.58） mg/L, （4.68 ± 3.42） ng/L, respectively ] than those in the normal controls [ （ 19.91± 7.76） ng/L, （ 1.43 ± 0. 72） μg/L, （ 540. 00± 78.70 ） ng/L, （ 0. 30 ±0. 16 ） mg/L, （ 7.41 ± 4.49 ） ng/L, respectively ] （ P 〈 0. 01 ）. ②Serum 8-isoPG, LTB4, TNF-α, and Hs-CRP levels elevated gradually following the severity of OSAHS while serum IL-10 level was decreased （ P 〈 0. 05 ）. ③Serum 8-isoPG, LTB4 , TNF-α, and Hs-CRP levels in OSAHS patients after sleep were correlated positively with AHI （r = 0. 863,0. 746,0. 868,0. 842, all P 〈0. 01 ） and negatively with LSpO2 （ r = - 0. 623, - 0. 524, - 0. 618, - 0. 562, all P 〈 0.01 ） and MSpO2 （ r = - 0. 654, - 0. 573, - 0. 537, - 0. 589, all P 〈 0. 01 ）. Serum IL-10 level in OSAHS patients was correlated negatively with AHI （ r = - 0. 722, P 〈 0. 01 ） and positively with LSpO2 （ r = 0. 564, P 〈 0. O1 ） and MSpO2 （ r = 0. 505, P 〈 O. 01 ）. ④ After three months of auto continuous positive air pressure （Auto-CPAP） or uvulopalatopharyngoplasty （UPPP） treatment, serum 8-isoPG, LTB4, TNF-α, and Hs-CRP levels of the OSAHS patients after sleep were obviously decreased [ （23.10 ± 9.54） ng/L, （4. 02± 2. 15） μg/L, （ 810. 25±
出处
《中国呼吸与危重监护杂志》
CAS
2009年第3期262-266,共5页
Chinese Journal of Respiratory and Critical Care Medicine
基金
江苏省南通市社会发展科技计划项目(编号:S2006050)
