重度阻塞性睡眠呼吸暂停低通气综合征患者血浆一氧化氮与内皮素-1水平测定的意义  

Alterations and Significance of Plasma Nitric Oxide and Enodthelia-1 in Patients with Severe Obstructive Sleep Apnea Hypopnea Syndrome

作　　者：彭易坤[1] 王树辉[2] 马祖霞[3] 胡德峰[1] 吴欣华[1] 李德宏[1] 

机构地区：[1]贵州省人民医院耳鼻咽喉头颈外科,贵州贵阳550002 [2]贵州省人民医院检验科,贵州贵阳550002 [3]遵义医学院第三附属医院耳鼻咽喉科,贵州遵义563002

出　　处：《武汉大学学报（医学版）》2014年第4期556-559,共4页Medical Journal of Wuhan University

基　　金：贵州省科技厅社会发展攻关项目(黔科合:SY[2010]3134)

摘　　要：目的:探讨重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血浆一氧化氮(NO)与内皮素-1(ET-1)水平以及手术治疗对NO和ET-1水平的影响。方法:经睡眠呼吸监测(PSG)检查确诊为重度OSAHS患者29例,依据是否伴有高血压分为A组(合并有高血压)和B组(无高血压),均行多平面分期手术,另选择30例年龄、性别、体重指数(BMI)等均相匹配的健康者作为对照组(C组)。采用固相夹心法酶联免疫吸附实验测定OSAHS患者术前、术后6个月血浆NO和ET-1水平,分析其与呼吸暂停低通气指数(AHI)及最低血氧饱和度(LSaO2)的相关性及术前、术后血浆NO和ET-1水平的变化。结果:A、B组血浆ET-1和ET-1/NO比值水平显著高于C组(P<0.05),且与AHI呈正相关(r=0.658,P<0.05),与LSaO2呈负相关(r=-0.543,P<0.05);NO显著低于对照组(P<0.05),29例OSAHS患者术后6个月血浆ET-1和ET-1/NO比值水平明显低于术前(P<0.05),而NO显著高于术前,且这种差异与BMI无关。结论:OSAHS患者存在血管内皮损伤,其中内皮功能失调在OSAHS合并高血压患者中更为明显;OSAHS患者血浆ET-1水平升高和NO水平下降,其原因可能与夜间反复多次发作呼吸暂停及低氧血症有关,有效的外科手术治疗可使血浆ET-1水平下降和NO水平升高。Objective： To investigate the plasma level of nitric oxide （NO） and endothelia-1 （ET-1） in patients with severe obstructive sleep apnea hypopnea syndrome（OSAHS）, and the impact of surgery therapy on NO and ET-1. Methods. Twenty-nine severe OSAHS patients who were diagnosed by polysomnogram （PSG） were divided into two groups, group A （with hypertension） and group B （without hypertension）, and all patients underwent multiplanar staging surgery. Thirtyage, gender and BMI matched healthy individuals were designated as control （group C）. Plasma NO and ET-1 were detected by ELISA before and six months after surgery. Results： ET-1 and the ratio of ET-1/NO in group A and B were significantly higher than in group C （P〈0.05）, NO in group A and B was significantly lower compared with control （P〈0.05）. The alterations of ET-1 and the ratio of ET-1/NO were positively correlated to AHI （r=0. 658, P%0.05）, and negatively correlated to LSaO2 （r=-0. 543, P%0.05）. ET-1 and the ratio of ET-1/NO in patients with OSAHS were reduced and NO was increased six months after surgery（P〈0.05）, however, the alterations had no relationship to BMI. Conclusion： Vascular endothelia were injuried in patients with OSAHS, and more severely in these patients with hypertension. The elevation of plasma ET-1 and reduction of NO may result from repeated apnea and hypoxemia. And the effective surgical treatment can decrease plasma ET-1 and elevate NO.

关 键 词：睡眠呼吸暂停低通气综合征 阻塞性 一氧化氮 内皮素-1 

分 类 号：R563.9[医药卫生—呼吸系统]