老年重叠综合征患者血管内皮功能的观察  

Observation on vascular endothelial function in elderly patients with overlap syndrome

作　　者：曹娟[1] 王滨[1] 张秀伟[2] 张希龙[3] 

机构地区：[1]南京医科大学附属无锡市人民医院老年科,江苏无锡214023 [2]南京医科大学附属江宁医院呼吸科,江苏南京210029 [3]南京医科大学第一附属医院呼吸科,江苏南京210029

出　　处：《中国医药科学》2011年第23期20-22,共3页China Medicine And Pharmacy

基　　金：2009年江苏省南京市第一批科技发展计划项目(200901093)

摘　　要：目的探讨重叠综合征的老年患者中血管内皮细胞功能状态及变化。方法将在笔者所在医院睡眠监测实验室作过睡眠监测的81例被检测的老年患者按照年龄、体重指数、性别比例相匹配的原则分为4组,即正常对照组(n=22)、COPD组(n=18)、OSAS组(n=20)和OS组(n=21)。通过比较各组清晨的血浆一氧化氮浓度、内皮素-1、NO/ET-1比值、及多导睡眠监测主要参数:呼吸暂停低通气指数、平均脉氧饱和度和最低脉氧饱和度及睡眠期间血氧饱和度<90%的时间占总睡眠时间的百分比,观察OS组血管内皮细胞功能变化的特点。结果血浆ET-1水平除正常对照组最低,OS组最高,NO水平于正常对照组最高,OS组最低。与正常对照组相比,COPD组及OSAS组的血浆ET-1增高、NO及NO/ET-1降低(P均<0.05),但该变化在OS组更为显著(P均<0.01)。上述指标在COPD组与OSAS组之间差异无统计学意义(P>0.05),但与OS组仍相差显著(P<0.05)。多导睡眠监测显示AHI在OSAS组及OS组之间以及在正常对照组和COPD组之间差异无统计学意义(P均>0.05),但AHI在OSAS组及OS组均显著高于正常对照组和单纯COPD组(P均<0.01)。OS组较OSAS组的最低和平均SpO2进一步降低,且T90比例显著增大(P均<0.01)。结论老年OS患者存在血管细胞功能损伤,其程度较单纯COPD及单纯OSAS更加严重,可能与睡眠期缺氧更明显和缺氧时间更长有关。Objective To investigate the effects of overlap syndrome,i.e,coexisting chronic obstructive pulmonary diseases and obstructive sleep apnea syndrome,on vascular endothelial function in the elderly, nehteds 81 elderly subjects were divided into four groups,normal control groupNC group,n=22）,COPD group（n=19）,obstructive sleep apnea group（n=21）,and OS group（n=21）.The age,gender,body mass index were marched among the four groups The changes of plasma nitricoxide and endothelin-l,rate of NO/ET-1 and the polysomnographic parameters including apnea hypopnea index（AHI）,mean and minimal pulse oxygen saturation （meanSpO2 and mini SpO2）,time for SpO2 〈 90%/total sleep time（T90）were compared among groups. Results The level of plasma endothelin-1（ET-1） was the lowest in NC group but the highest in OS group（P 〈 0.05）,while the level of plasma NO was the highest in NC group and the lowest in OS group（P 〈 0.05）.Compared with NC group,there were significant increase in plaasma ET-I levels but decrease in plasma NO level and NO/ET-1 （P 〈 0.05） in both COPD group and OSAS group.Such a change was more prominent in OS group （P 〈 0.01）. There were no significant difference in plasma NO,ET-1 levels and NO/ET-1 between COPD and OSAS group（P 〉 0.05）.No significant difference of AHI was detected between OSAS group and OS group,as well as between NC group and COPD group（P 〉 0.05）.However, the AHI in both OSAS group and OS group was significantly higher than NC and COPD group（P 〈 0.01）. Comparison between OS group and OSAS group demontrated a further devrease in minimal SpO2 （P 〈 0.01） and higher T90 in OS group（P 〈 0.01）.Conclusion Vascular endothelial damage could be detected in the elderly with OS and was more severe than that in the elderly with either COPD or OSAS.Such a pathological change might be associated with a more remarkable and longer hypoxiemia during sleep in OS patients.

关 键 词：重叠综合征 慢性阻塞性肺病 阻塞性睡眠呼吸暂停综合征 内皮素 一氧化氮 

分 类 号：R563.9[医药卫生—呼吸系统]