悬雍垂腭咽成形术对阻塞性睡眠呼吸暂停低通气综合征患者体内炎性反应因子的影响

目的探讨阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)患者炎性反应因子水平及悬雍垂腭咽成形术(uvulopalatopharyngolasty,UPPP)治疗对OSAHS患者炎性反应因子水平的影响。方法经多导睡眠图(PSG)监测确诊为OSAHS患者33例(男27例,女6例),中位年龄41(20～58)岁。健康对照组〔呼吸暂停低通气指数(AHI)<5〕行PSG筛查除外OSAHS27例(男22例,女5例),中位年龄42(18～59)岁。全部OSAHS患者接受UPPP手术治疗,6个月后复查各项指标。各组均于PSG监测后采空腹静脉血,放射免疫法检测血清肿瘤坏死因子-α(tumor necrosis factor-alpha,TNF-α)、白细胞介素-6(interleukin-6,IL-6)、白细胞介素-10(interleukin-10,IL-10),免疫透射比浊法检测血清C-反应蛋白(C-reactiveprotein,CRP)。结果与对照组比较,OSAHS组血清IL-6、INF-α及CRP物质的量浓度增高,血清IL-10质量浓度减低,差异有统计学意义(P均<0.05)。UPPP手术后AHI、血氧饱和度小于0.9时间占睡眠时间百分比(SLT90%)、最长呼吸暂停时间(LAT)、氧减指数(ODI)下降及夜间最低血氧饱和度(SaO2min)升高,血清IL-6、TNF-α质量浓度下降,差异均有统计学意义(P均<0.05);血清CRP、IL-10质量浓度与术前比较差异无统计学意义(P均>0.05)。结论OSAHS患者体内存在炎性反应因子失衡。UPPP手术治疗可一定程度改善缺氧,但不能完全纠正体内炎性反应因子失衡,手术后仍需辅助持续气道正压通气(CPAP)治疗。

Effect of Uvulopalatopharyngoplasty on Inflammatory Factors in Patients with Obstructive Sleep Apnea-hypopnea Syndrome

Objective To observe the effects of uvulopalatopharyngoplasty(UPPP) on inflammatory factors in patients with obstructive sleep apnea-hypopnea syndrome(OSAHS). Methods Thirty-three subjects, who were diagnosed by polysomnography(PSG) as OSAHS(AHI≥5, 27 men and 6 women), median age 41(20~58) years and 27 subjects as control(AHI＜5, 22 men and 5 women), median age 42(18~59 ) years, were studied. All patients with OSAHS were accepted UPPP and rechecked PSG after 6 months. All the blood samples were obtained after PSG. The concentrations of serum interleukin-6(IL-6), tumor necrosis factor-alpha(TNF-α) and interleukin-10(IL-10) were measured by radioimmunoassay. The concentrations of serum C-reactive protein(CRP) was measured by immunoturbidimetry. Results The level of serum IL-6, TNF-α and CRP in OSAHS group were significantly higher than those in control group. The concentration of serum IL-10 in OSAHS group was significantly lower than that in control(P<0.05 for all). The parameters including AHI, SLT 90%, LAT, ODI, and SaO₂min were significantly improved(P<0.05 for all), the levels of serum IL-6 and TNF-α significantly decreased(all P<0.05) after 6 months by UPPP therapy. There were no significant difference between serum CRP and IL-10 in patients with OSAHS who accepted UPPP(all P>0.05). Conclusion Systemic inflammatory imbalance exists in OSAHS patients. Although hypoxia was improved to some degree, UPPP could not correct inflammatory factors disorder completely in patients with OSAHS. The OSAHS patients should receive CPAP therapy after UPPP therapy.