阻塞性睡眠呼吸暂停综合征慢性间歇缺氧和炎症反应与非小细胞肺癌的相关性研究  

The Association of Chronic Intermittent Hypoxia and Inflammatory Response with Non-Small Cell Lung Cancer in ObstructiveSleep Apnea Syndrome

作　　者：薛明月 王艳丽 吴震 XUE Mingyue;WANG Yanli;WU Zhen(Department of Respiratory and Critical Care Medicine,Haian Hospital Affiliated to Nantong University,Haian 226600,China;Department of Respiratory and Critical Care Medicine,The First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南通大学附属海安医院呼吸与危重症医学科,江苏海安226600 [2]南京医科大学第一附属医院呼吸与危重症医学科,江苏南京210029

出　　处：《标记免疫分析与临床》2022年第8期1348-1353,共6页Labeled Immunoassays and Clinical Medicine

基　　金：国家自然科学基金(慢性间歇性低氧活化NLRP3炎症小体的促癌作用及机制研究)(编号:81800090)。

摘　　要：目的探讨阻塞性睡眠呼吸暂停综合征(OSAS)与非小细胞肺癌(NSCLC)发病和病情进展的相关性。方法将2020年1月至2021年12月收治的NSCLC患者90例列入观察组,根据是否合并OSAS分为单纯肺癌组(n=47)和合并OSAS组(n=43);选择同期诊治的OSAS患者和健康体检者各45例,列入对照一组和对照二组。行多导睡眠图(PSG)、血清和肺病变组织的免疫组化检查。比较4组的氧饱和度下降指数(ODI)、SpO_(2)<90%时间(TSat90)和最低血氧饱和度(LSpO_(2))水平,以及血清NLRP3炎症小体、缺氧诱导因子-1α(HIF-1α)和血管内皮生长因子(VEGF)水平;比较TNM各分期肺癌组织中的NLRP3炎症小体、HIF-1α和VEGF的表达水平。Pearson分析肺癌病灶NLRP3炎症小体、HIF-1α和VEGF的表达水平与呼吸暂停低通气指数(AHI)、睡眠呼吸暂停临床评分和血清内皮型一氧化氮合酶(eNOS)、ICAM-1水平的相关性。结果合并OSAS肺癌组的ODI和TSat90显著高于对照一组、单纯肺癌组和对照二组,LSpO_(2)显著降低(P<0.05)。合并OSAS肺癌组的NLRP3炎症小体、HIF-1α和VEGF水平高于对照一组、单纯肺癌组和对照二组(P<0.05)。观察组中Ⅳ期肺癌组织的NLRP3炎症小体、HIF-1α和VEGF表达水平显著高于Ⅲ期和Ⅰ~Ⅳ期(P<0.05)。Pearson分析显示,肺癌病灶NLRP3炎症小体、HIF-1α和VEGF的表达水平与AHI、SACS评分和血清ICAM-1水平呈正相关,与血清eNOS水平呈负相关(P<0.001)。结论OSAS与肺癌的发生和病情进展密切相关,低氧状态和炎症应激反应是主要致病因素,可作为临床诊断和治疗的切入点,改善疾病预后。Objective To investigate the correlation between obstructive sleep apnea syndrome(OSAS)and the incidence and progression of non-small cell lung cancer(NSCLC).Methods Ninety NSCLC patients admitted from January,2020 to December,2021 were included in the observation group,and were divided into the simple lung cancer group(n=47)and OSAS group(n=43)according to whether there was OSAS.Forty-five OSAS patients and 45 healthy subjects were included in the control group 1 and control group 2,respectively.Polysomnography(PSG)and immunohistochemical examination of serum and lung lesions were performed.Oxygen desaturation index(ODI),SpO_(2)<90%time(TSat90)and lowest blood oxygen saturation(LSpO_(2))levels,as well as serum NLRP3 inflammatory body,hypoxia-induced factor-1α(HIF-1α)and vascular endothelial growth factor(VEGF)levels were compared among the four groups.The expression levels of NLRP3 inflammasome,HIF-1αand VEGF in TNM lung cancer tissues were compared.Pearson analysis was conducted among NLRP3 inflammasome,HIF-1αand VEGF expression levels and apnea hypopnea index(AHI),sleep apnea clinical score and serum endothelial nitric oxide synthase(eNOS),ICAM-1 levels.Results ODI and TSat90 of the OSAS lung cancer group were significantly higher than those of the control 1 group,lung cancer alone group and control 2 group,while LSpO2 was significantly decreased(P<0.05).Levels of NLRP3 inflammasome,HIF-1αand VEGF in the OSAS group were higher than those in the control 1 group,lung cancer alone group and control 2 group(P<0.05).The expression levels of NLRP3 inflammasome,HIF-1αand VEGF in the stage iv lung cancer group were significantly higher than those in stageⅲand stage i-iv(P<0.05).Pearson analysis showed that the expression levels of NLRP3 inflammasome,HIF-1αand VEGF were positively correlated with AHI,SACS score and serum ICAM-1 level,while negatively correlated with serum eNOS level(P<0.001).Conclusion OSAS is closely related to the occurrence and progression of lung cancer.Hypoxia and inflammatory stress resp

关 键 词：非小细胞肺癌 阻塞性睡眠呼吸暂停综合征 缺氧 炎症 预后 

分 类 号：R734.2[医药卫生—肿瘤]