连续正压通气治疗对阻塞性睡眠呼吸暂停低通气综合征患者炎症和氧化应激标记物的影响

发布时间：2018-05-02 02:19

本文选题：肺疾病 + 慢性阻塞性　；参考：《中国全科医学》2014年13期

【摘要】：目的观察3个月的连续正压通气(CPAP)治疗对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者诱导痰及血清中肿瘤坏死因子(TNF-α)、白介素-6(IL-6)、8-异前列腺素、硝基酪氨酸的影响。方法选取2012年1月—2013年2月在南昌市中西医结合医院呼吸科采用多导睡眠图(PSG)诊断为中度或重度的OSAHS患者32例,进行定期3个月的CPAP治疗,在治疗前后进行PSG检查,并检测空腹血和诱导痰中标志物水平。结果 CPAP治疗3个月后,呼吸暂停低通气指数(AHI)〔(44.5±23.2)次/h比(4.1±3.2)次/h〕、指氧减饱和度(ODI)〔(35.8±26.1)%比(5.9±5.7)%〕、觉醒指数〔(36.4±24.8)次比(7.2±4.3)次〕、血氧饱和度(SaO2)〔(91.2±4.6)%比(94.7±2.8)%〕、最低血氧饱和度〔(72.4±12.8)%比(82.5±13.1)%〕、快速眼动(REM)〔(12.2±2.7)次比(19.6±3.0)次〕差异均有统计学意义(P0.05);(2)CAPA治疗前后诱导痰中IL-6〔(1.4±2.2)ng/L比(0.3±0.1)ng/L〕、TNF-α〔(27.8±1.4)ng/L比(26.4±1.7)ng/L〕、硝基酪氨酸〔(18.2±9.8)ng/L比(5.6±3.5)ng/L〕以及8-异前列腺素〔(5.6±7.4)ng/L比(0.3±1.2)ng/L〕水平降低,差异均有统计学意义(P0.05);(3)治疗后血清中硝基酪氨酸〔(5.4±2.2)ng/L比(0.4±0.5)ng/L〕以及8-异前列腺素〔(102.6±159.8)ng/L比(36.7±25.4)ng/L〕水平降低,差异均有统计学意义(P0.05),而CRP〔(8.2±8.5)ng/L比(6.8±4.2)ng/L〕、IL-6〔(1.8±1.0)ng/L比(2.5±1.4)ng/L〕、TNF-α〔(23.5±2.8)ng/L比(23.3±3.6)ng/L〕差异无统计学意义(P0.05)。结论 CPAP治疗可以明显降低OSAHS患者的上气道炎症和氧化应激水平,还可以减少全身血清氧化应激水平,但对全身炎症反应改善不明显。
[Abstract]:Objective to observe the effects of continuous positive pressure ventilation (CPAP) for 3 months on induced sputum and serum tumor necrosis factor TNF- 伪 (TNF- 伪), interleukin-6 (IL-6) IL-6- isoprostaglandin, nitrotyrosine in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods from January 2012 to February 2013, 32 patients with moderate or severe OSAHS diagnosed by polysomnography in respiratory department of integrated Chinese and western medicine hospital in Nanchang City were selected and treated with CPAP for 3 months. PSG examination was performed before and after treatment. The levels of markers in fasting blood and induced sputum were detected. Results after 3 months of CPAP treatment, the apnea hypopnea index was 44.5 卤23.2times / h vs 4.1 卤3.2times / h, the oxygen desaturation was 35.8 卤26.1% vs 5.9 卤5.7 / h, the arousal index was 36.4 卤24.8times vs 7.2 卤4.3 / h, and the oxygen saturation was 91.2 卤4.6% vs 94.7 卤2.8g / h, respectively. The lowest blood oxygen saturation was 72.4 卤12.8% vs 82.5 卤13.1g / L and 12.2 卤2.7times vs 19.6 卤3.0times respectively.) there were significant differences in the IL-6((1.4 卤2.2)ng/L ratio of induced sputum before and after treatment. The ratio of IL-6((1.4 卤2.2)ng/L to TNF- 伪 was 27.8 卤1.4)ng/L to 26.4 卤1.7ngL / L, respectively, before and after treatment with CAPA-induced sputum (P < 0.05 卤12.8g / L = 0.30 卤0.1ng / L = 27.8 卤1.4)ng/L vs 26.4 卤1.7ngL / L). After treatment, the levels of nitrotyrosine tyrosine (18.2 卤9.8)ng/L vs 5.6 卤3.5 ng / L) and 8-isoprostaglandin (5.6 卤7.4)ng/L vs 0.3 卤1.2 ng / L) decreased significantly after treatment (P 0.05). The levels of nitrotyrosine tyrosine were 5.4 卤2.2)ng/L vs 0.4 卤0.5ngP / L and 102.6 卤159.8)ng/L vs 36.7 卤25.4ngP / L, respectively. The difference was statistically significant (P < 0.05), but there was no significant difference between CRP((8.2 卤8.5)ng/L and CRP((8.2 卤8.5)ng/L (6.8 卤4.2 ng / L, 1.8 卤1.0)ng/L vs 2.5 卤1.4 ng / L, 23.5 卤2.8)ng/L vs 23.3 卤3.6 ng / L). Conclusion CPAP treatment can significantly reduce the level of upper airway inflammation and oxidative stress in patients with OSAHS, as well as the level of serum oxidative stress in patients with OSAHS, but the improvement of systemic inflammatory response is not obvious.
【作者单位】：江西省南昌市中西医结合医院呼吸科;江西科技学院;南昌市中西医结合医院急诊科;
【基金】：南昌市科技计划〔洪财企业(2012)80号-2-3〕
【分类号】：R563.8

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