呼出气一氧化氮在阻塞性睡眠呼吸暂停低通气综合征中的应用与评价

发布时间：2018-03-04 06:37

本文选题：呼出气一氧化氮　切入点：仪器比较　出处：《复旦大学》2013年博士论文　论文类型：学位论文

【摘要】：第一部分两种呼出气一氧化氮测定仪器的应用比较目的：比较两种呼出气一氧化氮仪器,分析他们测定结果的关联与一致性。方法：本研究共纳入45例受试者,包括：(1)健康志愿者；(2)支气管哮喘患者；(3)慢性阻塞性肺疾病患者；(4)诊断未明确但有呼吸系统症状者。受试者以随机顺序进行同时段两种呼出气一氧化氮分析仪器(Sunvou纳库伦一氧化氮分析仪和Niox Mino)的检测,测定呼吸流速为50m1/s下的呼出气一氧化氮浓度。统计学分析采用SPSS19.0。结果：两种仪器的测定结果对比未见显著性差异(P=0.1047),且具有良好的相关性(r=0.8647,P0.0001),并拟合出转换方程：FeNONiox Mino=0.6233(SE=0.0552)×FeNOSunvou+10.38(SE=2.78)。将健康志愿者与哮喘患者分组分析,亦未发现测定结果之间存在显著差异。Bland-Atman分析发现虽然两种仪器总体测定结果的一致性较差,但多集中于测试高值。结论：Sunvou纳库伦一氧化分析仪与Niox Mino测定结果之间具有良好的相关性。这一结果为临床两种仪器测定结果的比较与解读提供了参考,同时也为后续利用纳库伦一氧化氮分析仪进行多呼气流速下呼出气一氧化氮测定的可靠性与准确性提供了依据。第二部分阻塞性睡眠呼吸暂停低通气综合征患者分段呼出气一氧化氮的测定与意义目的：利用二室模型对呼出气一氧化氮进行分段测定,探索阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者中呼出气一氧化氮的变化与意义。方法：根据入组、排除标准,本研究共纳入非OSAHS对照组(Non-OS AHS)受试者27例,OSAHS患者32例。所有受试者记录基本信息、Epworth嗜睡量表(ESS)评分,并进行常规肺功能测定和同时段(20：00-21：00)的分段呼出气一氧化氮测定。其中所有OSAHS者均记录多导睡眠监测相关指标。统计学分析采用SPSS19.0. 结果：通过对比Non-OSAHS组,我们发现在OSAHS患者中：(1) FeNO (50ml/s)和J'awNO测定结果显著升高,FeNO (50ml/s)与呼吸暂停低通气指数(AHI)、夜间平均氧饱和度(Sa02)、夜间SaO290%占总睡眠时间的百分比以及夜间SaO290%的总睡眠时间等显著相关；J'awNO亦与AHI、夜间Sa0290%睡眠时间、以及夜间Sa0290%睡眠时间占总睡眠时间的百分比具有显著相关性；(2)CANO略有降低,与多导睡眠监测相关指标无相关性；(3)FeNO(50ml/s)、 J'awNO和CANO均未显示与ESS评分具有关联。结论：OSAHS存在大气道(呼吸道导气部)的炎症、氧化应激水平增高,且与疾病的严重程度相关。CANO的降低可能与缺氧、炎症所致的内皮功能障碍有关,其潜在机制还有赖于进一步研究。对OSAHS患者进行分段呼出气一氧化氮的测定,可为深入认识发病机制与疾病监测提供帮助。第三部分经鼻持续气道内正压通气对重度OSAHS患者分段呼出气一氧化氮的影响与意义目的：探索经鼻持续气道正压通气(nCPAP)治疗对重度OSAHS患者分段呼出气一氧化氮水平的影响及其潜在临床意义。方法：根据入组、排除标准,本部分研究共纳入接受连续3晚CPAP治疗的重度OSAHS患者30例。记录受试者基本信息,且在每次nCPAP治疗前(晚睡前)、后(晨起后)均进行分段呼出气一氧化氮的测定；采集治疗前后静脉血测定血浆内皮素-1(ET-1)浓度；并在治疗前后行超声心动图检查评价右室功能。统计学分析采用SPSS19.0。结果：所有受试者均接受了nCPAP治疗前后的分段呼出气一氧化氮测定；20例受试者同意进行治疗前后静脉血采集,测定血浆ET-1浓度；22例受试者同意进行超声心动图检查评价右室功能；13例受试者完整地接受了治疗前后的心超检查。结果发现：(1) FeNO (50ml/s)、J'awNO经nCPAP治疗后均显著降低；CANO则显著上升；(2)对比治疗前后同时段血浆ET-1浓度变化发现连续3晚nCPAP治疗可显著降低其浓度,且OSAHS患者CANO的变化与血浆ET-1浓度的变化趋势之间具有一致性,但变化程度上并不具相关性；(3) nCPAP治疗可改善右室功能,使做功减少,表现为Tei指数降低,而Tei指数与患者血浆ET-1浓度之间存在显著正相关。结论：对重度OSAHS患者进行分段呼出气一氧化氮检测具有反映肺部炎症、氧化应激水平、内皮损伤与功能障碍、血管活性物质、肺循环阻力及右心功能变化等作用,对改善因OSAHS可能导致的远期心血管事件或许有重要参考价值,有助于疾病的临床治疗、监测与随访。
[Abstract]:The first part of the application of two kinds of exhaled nitric oxide measuring instruments
Objective: To compare two kinds of exhaled nitric oxide instruments and analyze the correlation and consistency of their results.
Methods: 45 patients were enrolled in the study subjects: (1) healthy volunteers; (2) patients with bronchial asthma; (3) in patients with chronic obstructive pulmonary disease; (4) the diagnosis is not clear but the symptoms of respiratory system. At the same time the subjects were two kinds of exhaled nitric oxide in analytical instruments random order (Sunvou Na Kulun nitric oxide analyzer and Niox Mino) detection, determination of respiratory flow rate of exhaled nitric oxide concentration of 50m1/s. Statistical analysis by SPSS19.0.
Results: the results of two kinds of instruments compared with no significant difference (P=0.1047), and has a good correlation (r=0.8647, P0.0001), and fit the conversion equation: FeNONiox Mino=0.6233 (SE=0.0552) * FeNOSunvou+10.38 (SE=2.78). The group of healthy volunteers and patients with asthma, also found no significant difference between the determination results of.Bland-Atman the analysis found that although the two instruments overall results consistency is poor, but more concentrated in the test of high value.
Conclusion: there is a good correlation between Sunvou nano Kulun oxide analyzer and Niox Mino results. Provide a reference comparison and interpretation of the results for the clinical determination results of two kinds of instruments, but also the accuracy and reliability of exhaled nitric oxide measurement provides the basis for the subsequent use of nano Kulun nitric oxide analyzer multi expiratory flow.
Determination and significance of sectional exhaled nitric oxide (NOS) in second parts of obstructive sleep apnea hypopnea syndrome
Objective: To explore the change and significance of exhaled nitric oxide in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) by two compartment model.
Methods: according to the inclusion, exclusion criteria, were included in the study of non OSAHS control group (Non-OS AHS) of 27 subjects, 32 cases of OSAHS patients. All subjects record the basic information, the Epworth sleepiness scale (ESS) score, and routine pulmonary function test and at the same time (20:00-21:00) of the segmented breath the gas nitric oxide measurement. All OSAHS were recorded by sleep related indicators were analyzed by SPSS19.0. monitoring.
Results: compared with the Non-OSAHS group, we found that in patients with OSAHS (1): FeNO (50ml/s) and J'awNO were significantly increased, FeNO (50ml/s) and apnea hypopnea index (AHI), average nighttime oxygen saturation (Sa02), the percentage of SaO290% was significantly related to total nocturnal sleep time and night time SaO290% the total sleep time; J'awNO and AHI, Sa0290% at night sleep time, sleep time and night Sa0290% percentage of total sleep time has significant correlation; (2) CANO decreased slightly, no correlation with multichannel sleep related indicators monitoring; (3) FeNO (50ml/s), J'awNO and CANO showed no ESS the score is associated.
Conclusion: OSAHS airway (respiratory gas Department) inflammation, increased oxidative stress, and the severity of.CANO and a decrease in disease may be related to hypoxia, inflammation induced endothelial dysfunction and its potential mechanism also depends on the further study. The OSAHS patients were measured sections of exhaled nitric oxide, disease the mechanism and disease monitoring to provide help for understanding.
The effect and significance of the third part of the nasal continuous positive airway pressure ventilation on the segmented exhaled nitric oxide in severe OSAHS patients
Objective: To explore the effect and potential clinical significance of transnasal continuous positive airway pressure (nCPAP) therapy on the level of sectional exhaled nitric oxide (no) in severe OSAHS patients.
Methods: according to the inclusion, exclusion criteria, the study included 3 consecutive nights to accept CPAP treatment of patients with severe OSAHS. 30 cases were recorded in each of the basic information, and nCPAP before treatment (night), (after the morning) were measured sections of exhaled nitric oxide; collecting vein before and after treatment blood plasma -1 (ET-1) concentration; and before and after treatment for echocardiography right ventricular function evaluation were analyzed by SPSS19.0..
Results: all subjects underwent a segment of exhaled nitric oxide was measured before and after nCPAP treatment; 20 subjects agreed to before and after the treatment of venous blood collection, the determination of plasma ET-1 concentration; 22 subjects agreed to echocardiography right ventricular function evaluation; 13 subjects received treatment before and after complete heart ultrasound. Results showed that: (1) FeNO (50ml/s), J'awNO after nCPAP treatment were significantly decreased; CANO increased significantly; (2) comparison before and after treatment and changes of plasma ET-1 concentration was found for 3 consecutive nights, nCPAP treatment can significantly reduce its concentration, consistent with changes in patients with OSAHS and CANO the plasma level of ET-1 and the trend of change, but the extent is not relevant; (3) nCPAP treatment can improve right ventricular function, reduce the work, performance for the Tei index decreased, while the Tei index and plasma ET-1 concentration between Significant positive correlation.
Conclusion: the segmentation of exhaled nitric oxide detection can reflect the inflammation in the lungs of patients with severe OSAHS, oxidative stress, vasoactive substances, endothelial injury and dysfunction, pulmonary vascular resistance and right heart function changes, to improve the result of OSAHS may lead to long-term cardiovascular events may have important reference value for clinical treatment contributes to the disease. Monitoring and follow-up.

【学位授予单位】：复旦大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R766

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