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± 135.85 ） ng/L, （ 0. 79 ±0. 60 ） mg/L, respectively ], and serum IL-10 level was obviously increased [ （ 6. 93±3.91 ） ng/L 1 （ P 〈 0. 01 ）. ⑤ serum 8-isoPG and IL-10 had no statistics difference and serum LTB4, TNF-α, Hs-CRP levels were higher in OSAHS underwent therapy compared with the normal controls. Conclusions The results suggest that inflammation and oxidative stress are activated and antiflammatory cytokines are decreased in the OSAHS patients. The serum levels of 8-isoPG, LTB4, TNF-α, Hs-CRP and IL-10 may prove to be useful in severity monitoring and intervention efficacy judgement in OSAHS patients.
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)
