血清白细胞介素-6 C反应蛋白在阻塞性睡眠呼吸暂停通气综合征及其合并冠心病患者体内的水平变化

摘要

目的 通过检测阻塞性睡眠呼吸暂停低通气综合征(OSAHS)及OSAHS合并冠心病(CAD)患者血清白细胞介素-6(IL-6)及C反应蛋白(CRP)水平的变化,研究两者与OSAHS及OSAHS合并CAD的相关性,旨在探讨OSAHS合并冠心病的发病机制.方法 随机选择经多导睡眠图(PSG)监测确诊的OSAHS患者60例,其中单纯OSAHS患者40例,OSAHS合并CAD患者20例.另选择我院同期健康体检者30名.于睡眠呼吸监测次日晨起采取空腹肘静脉血3 ml,采用放射免疫法测定IL-6,酶联免疫吸附试验测定CRP,并记录睡眠呼吸监测相关指标,对其结果进行分析.结果 单纯OSAHS组、OSAHS合并CAD组与健康对照组相比血清IL-6、CRP浓度均升高,差异有统计学意义(P＜0.01).OSAHS合并CAD组血清IL-6、CRP浓度均高于单纯OSAHS组,差异有统计学意义(P＜0.01).OSAHS合并CAD组与单纯OSAHS组相比,睡眠呼吸暂停低通气指数(AHI)升高,差异有统计学意义(P＜0.01);最低血氧饱和度(SaO2)及平均SaO2均降低,差异有统计学意义(P＜0.01);但最长呼吸暂停时间及最长低通气时间差异均无统计学意义(P＞0.05).单纯OSAHS组与OSAHS合并CAD组2组患者血清IL-6和CRP均呈正相关(r分别为0.941与0.922,P＜0.01).不论单纯OSAHS组还是OSAHS合并CAD组,血清IL-6、CRP水平均与AHI呈正相关,与最低SaO2呈负相关,而与最长呼吸暂停时间及最长低通气时间无相关性.结论 OSAHS可能存在着一个慢性炎症过程,它在OSAHS合并CAD的发生发展中起着重要作用.%Objective To detect the variation of serum interleukin-6 (IL-6) and C-reactive protein (CRP) levels in patients with obstructive sleep apnea hypoventilation syndrome (OSAHS) and in those with accompanying coronary artery disease (CAD) (OSAHS+CAD), and to study the correlation between the two biomarkers, OSAHS and OSAHS+CAD, in order to explore the pathogenesis of OSAHS+CAD. Methods Sixty patients confirmed with OSAHS by polysomnography (PSG) were randomly . The subjects comprised 40 pure OSAHS patients and 20 with OSAHS+CAD.In addition, 30 contemporary healthy subjects undergoing workup were selected to be the normal controls. Three mlfasting venous blood was obtained from all studied subjects the next morning after sleep apnea monitoring. The serum IL-6 level was detected with radioimmunologic assay (RIA) and the CRP level with enzyme linked immunosorbent assay (ELISA). Moreover, the relevant sleep apnea parameters were recorded. The outcomes were then analyzed. Results The serum IL-6 and CRP levels were both elevated in pure OSAHS group and in OSAHS+CAD group as compared with normal controls (P＜0.01). Notably, the serum IL-6 and CRP concentrations were higher in OSAHS+CAD group than in OSAHS group (P＜0.01). Compared with the pure OSAHS group, the OSAHS+CAD group was elevated in apnea hyponea index (AHI) (P＜0.01) but lowered in both the lowest SaO2 and mean SaO2 (P＜0.01), whereas there were no differences in the longest duration of apnea and hypopnea between the two groups (P＞0.05). The serum IL-6 level were positively correlated with serum CRP level in both OSAHS and OSAHS+CAD groups (r=0.941, r=0.922 respectively,P＜0.01). The serum IL-6 and CRP levels were correlated positively with AHI both in OSAHS and OSAHS+CAD groups and negatively with the lowest SaO2, but not with longest duration of apnea/hypopnea. Conclusion The inflammatory response level, significantly higher in OSAHS+CAD group than in OSAHS and normal control groups, may speculate a chronic inflammatory process in OSAHS that plays an important role in the occurrence and development of OSAHS+CAD.