持续气道正压通气对阻塞性睡眠呼吸暂停低通气综合征呼气冷凝液内皮素—1水平的影响

巫翠华 黄立霞 李志莹 杜秀芳 黄平

[摘要] 目的 探讨持续气道正压通气（CPAP）对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者呼出气冷凝液（EBC）中内皮素-1（ET-1）水平的影响及其临床意义。 方法 从2011年9月～2014年2月在广东医学院附属南山医院呼吸科因打鼾就诊患者中选择73例非吸烟OSAHS患者，另匹配23名健康非吸烟者（对照组）;用EBC收集仪器采集睡前、晨起EBC，酶联免疫吸附试验法测定ET-1浓度，其中19例中重度OSAHS患者（CPAP组）经使用持续气道正通气治疗3个月后，复查EBC中的ET-1浓度，并进行统计学分析。 结果 组内比较：对照组晨起ET-1水平[（5.04±0.36）ng/L]与睡前[（5.11±0.45）ng/L]比较，差异无统计学意义（t=0.675，P > 0.05）。OSAHS组晨起ET-1水平[（13.27±1.43）ng/L]较睡前[（5.07±0.51）ng/L]升高，差异有高度统计学意义（t=54.767，P < 0.01）。组间比较： OSAHS组晨起ET-1水平[（13.27±1.43）ng/L]较对照组[（5.04±0.36）ng/L] 升高，差异有高度统计学意义（t=50.257，P < 0.01）;而OSAHS组睡前ET-1水平[（5.07±0.51）ng/L]与对照组[（5.11±0.45）ng/L]比较，差异无统计学意义（t=0.558，P > 0.05）;经3个月CPAP治疗后，CPAP组晨起ET-1水平[（7.01±0.63）ng/L]较治疗前[（13.41±1.26）ng/L]降低，差异有统计学意义（t=20.502，P < 0.05）;经3个月CPAP治疗后，睡前ET-1水平[（5.09±0.41）ng/L]与治疗前[（5.03±0.35）ng/L]比较，差异无统计学意义（t=0.721，P > 0.05）;OSAHS患者晨起EBC中ET-1浓度与颈围、睡眠呼吸暂停低通气指数呈正相关（r=0.254、0.596，P < 0.05），与睡眠中最低血氧饱和度呈负相关（r=-0.563，P < 0.05）。 结论 OSAHS患者晨起EBC中ET-1水平能通过CPAP治疗降低，晨起EBC中ET-1可作为随访病情和反映治疗效果的指标。

[关键词] 阻塞性睡眠呼吸暂停低通气综合征;呼出气冷凝液;内皮素-1;持续气道正压通气

[中图分类号] R766          [文献标识码] A          [文章编号] 1673-7210（2015）01（a）-0030-05

Effect of treatment of continuous positive airway pressure of Endothelin-1 in exhaled breath condensate of patients with obstructive sleep apnea hypopnea syndrome

WU Cuihua   HUANG Lixia   LI Zhiying   DU Xiufang   HUANG Ping

Department of Respiratory Medicine， the Affiliated Nanshan Hospital of Guangdong Medical College， Guangdong Province， Shenzhen   518052， China

[Abstract] Objective To examine the effect of treatment of continuous positive airway pressure （CPAP） of Endothelin-1 （ET-1） in exhaled breath condensate （EBC） of patients with obstructive sleep apnea hypopnea syndrome （OSAHS）. Methods Patients who complained of loud snoring， who had been referred to Department of Respiratory Medicine of the Affiliated Nanshan Hospital of Guangdong Medical College （from September 2011 to February 2014） owing to suspicion of OSAHS， were used as sources for OSAHS patients. 73 patients with OSAHS （non smokers） and 23 matched normal control subjects （healthy nonsmokers） were enrolled in this study. EBC was collected before and after sleep at the same night from groups. ET-1 in EBC was measured by a specific enzyme immunoassay. They were detected again in the nineteen patients from the moderate-severe group after treated with CPAP （CPAP group） for 3 months. Results Intra-group comparison： there was no difference between post-sleep ET-1 level [（5.04±0.36） ng/L] and pre-sleep ET-1 level [（5.11±0.45） ng/L] in control subjects （t=0.675， P > 0.05）. The concentrations of ET-1 [（13.27±1.43） ng/L] in EBC post-sleep were significantly higher than those in pre-sleep [（5.07±0.51） ng/L] in 73 OSAHS patients （t=54.767， P < 0.01）. Compaison among groups： there was difference in post-sleep ET-1 level between OSAHS [（13.27±1.43） ng/L] and the control subjects [（5.04±0.36） ng/L] （t=50.257， P < 0.01）. There was no difference in the pre-sleep ET-1 level between OSAHS [（5.07±0.51） ng/L] and the control subjects [（5.11±0.45） ng/L] （t=0.558， P > 0.05）. After 3 months of CPAP therapy， the concentration of ET-1 in EBC post - sleep of patients in CPAP group showed a significant reduction from （13.41±1.26） ng/L to （7.01±0.63） ng/L （t=20.502， P < 0.05）. There was no change in the pre-sleep ET-1 level between before treatment [（5.03±0.35） ng/L] and after treatmen [（5.09±0.41） ng/L] in CPAP group （t=0.721， P > 0.05）. The concentrations of ET-1 in EBC of OSAHS patients post- sleep were positive correlated with neck circumferences and AHI （r=0.254， 0.596， P < 0.05）， and negative with minimal oxygen saturation （r=-0.563， P < 0.05）. Conclusion CPAP treatment can reduce the levels of post-sleep ET-1 in EBC of OSAHS， and it can be an index for follow-up and to reflect effect of treatment.

[Key words] Obstructive sleep apnea hypopnea syndrome; Exhaled breath condensate; Endothelin-1; Continuous positive airway pressure

阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome，OSAHS）是具有潜在危险性的慢性睡眠呼吸疾病，由于夜间低氧血症反复发作，常导致多脏器功能损害，尤其是心脑血管并发症。现有研究表明，OSAHS存在着全身和局部的炎症及氧化应激状态。呼出气冷凝液（exhaled breath condensate，EBC）是一种无创检测方法，在收集标本过程中，它不干扰呼吸道本身的生理和病理过程，尤其对于老幼体弱、病情严重者，EBC取样简单、无创、实时、可以反复应用的优势突出[1-4]。现有研究表明，OSAHS患者的气道中存在炎症和氧化应激反应。EB……