老年阻塞性睡眠呼吸暂停低通气综合征患者CD8^＋T细胞功能的变化  

Functional changes of CD8^＋ T lymphocytes in elderly patients with obstructive sleep apnea hypopnea syndrome

作　　者：高兴林[1] 黄作平 欧琼[1] 岑瑞金[1] 叶春幸[1] 

机构地区：[1]广东省人民医院东病区呼吸科广东省老年医学研究所 ,广州市510080 [2]解放军武警广东总医院

出　　处：《中华老年医学杂志》2007年第9期645-648,共4页Chinese Journal of Geriatrics

基　　金：广东省科技攻关项目（2005B30601009）

摘　　要：目的探讨CD8^＋T细胞在阻塞性睡眠呼吸暂停低通气综合征（OSAHS）发病中的作用。方法选取60岁以上的老年人为观察对象,均行多导睡眠监测（PSG）,按PSG结果将其分为健康对照组17例、轻度OSAHS组21例、中度OSAHS组20例和重度OSAHS组17例。于患者早晨睡醒后采外周静脉血2ml,分离单个核细胞。流式细胞仪测定活化CD8^＋T细胞的百分比、CD8^＋T细胞内肿瘤坏死因子α（TNFα）及穿孔素的表达。部分中、重度OSAHS患者经持续气道正压通气（CPAP）治疗后复查上述指标。结果（1）健康对照组与轻、中、重度OSAHS患者活化的CD8^＋T细胞/CD8^＋T细胞的百分比分别为7.5%±0.7%、8.3%±0.8%、12.3%±1.8%和13.4%±2.0%,轻度OSAHS患者与健康对照组比较,差异无统计学意义（P〉0.05）,而中、重度OSAHS患者与健康对照组比较,差异有统计学意义（P〈0.01）;随着OSAHS患者病情的加重,活化的CD8^＋T细胞/ CD8^＋T细胞的百分比则随之升高,各OSAHS组两两比较,差异均有统计学意义（P〈0.01）。（2） CD8^＋T细胞表达TNFα的阳性率,轻度OSAHS患者与健康对照组比较,差异无统计学意义（P〉0.05）,而中度及重度OSAHS患者较健康对照组明显增高,差异有统计学意义（P〈0.01）;且随病情的加重,CD8^＋T细胞表达TNFα的阳性率更高。CD8^＋T细胞表达穿孔素3组患者均较健康对照组明显增高,差异有统计学意义（均为P〈0.01）,且随病情的加重,CD8^＋T细胞表达穿孔素也明显增加。（3）部分中、重度OSAHS患者经CPAP治疗后,CD8^＋T细胞胞内表达TNFα及穿孔素明显减少。结论OSAHS患者活化的CD8^＋T细胞数目增多,产生炎症介质及细胞毒物质增加,这些可能在OSAHS的发病过程中起作用。Objective To investigate the functional changes of CD8^＋ T-lymphocytes in elderly patients with obstructive sleep apnea hypopnea syndrome（OSAHS）.Methods Subjects older than sixty years were devided into normal（n=17）,mild（n=21）,moderate（n=20）,severe（n=17）OSAHS groups according to polysomnography（PSG）.There were no significant differences in age and sex distribution between patients with OSAHS and controls（P〉0.05）.Samples of peripheral venous blood were collected,and blood mononuclear cells were isolated.Then the percentages of activated CD8^＋ T-lymphocytes,the espressions of intracellular TNFαand perforin in CD8^＋ T-lymphocytes were detected by flow cytometry.In addition,some patients with moderate-to-severe OSAHS were re investigated after treatment with nasal continuous positive airway pressure（CPAP）.Results（1） The percentage of the activated CD8^＋ T cells were 7.5%±0.7%,8.3%±0.8%,12.3%±1.8%, 13.4%±2.0% in the subjects of the normal,mild,moderate,severe OSAHS groups,respectively. The percentages were significantly higher in moderate-to-severe OSAHS groups than in the controls （P〈0.01）,and differed significantly among each OSAHS group（P〈0.01）,but no differences were found between mild OSAHS and controls（P〉0.05）.（2）The percentage of CD8^＋ T-lymphocytes expressing TNFa were significantly higher in moderate-to-severe OSAHS than in the controls（P〈0.01）,but no difference was found between the mild OSAHS and controls（P〉0.05）.And the percentage was positively correlated with the severity of the syndrome.The intracellular perforin level significantly increased in OSAHS CD8^＋ T-lymphoeytes compared with the controls（P〈0.01）,and was positively correlated with the severity of the syndrome.（3）nCPAP treatment significantly decreased the expressions of both TNFαand perforin in CD8^＋ T-lymphocytes.Conclusions The activated CD8^＋ T-lymphocytes are increased in OSAHS patients,and produce higher levels of inflammatory cytokines

关 键 词：阻塞性睡眠呼吸暂停低通气综合征 CD8阳性T淋巴细胞 肿瘤坏死因子Α 炎症介导素类 细胞毒素类 老年人 

分 类 号：R686[医药卫生—骨科学]