阻塞型睡眠呼吸暂停低通气综合征与血管内皮功能

睡眠呼吸暂停低通气综合征（sleep apnea-hypopnea syndrome，SAHS）是指每晚7小时睡眠中，呼吸暂停反复发作在30次以上或睡眠呼吸暂停低通气指数（AHI）超过5次以上。阻塞型睡眠呼吸低通气综合征（OSAHS）是最常见的一种类型，占90％以上。它以睡眠中反复出现的呼吸暂停、觉醒、低氧血症和高碳酸血症为特征，在临床上常可引起心、脑、肾等多系统器官功能损害。     

重叠综合征研究概况

阻塞性睡眠呼吸暂停低通气综合征（OSAHS）是一种慢性睡眠呼吸疾患，其特征是睡眠状态中反复发生上气道完全和（或）不完全阻塞，伴有间断的低氧血症或合并高碳酸血症，睡眠结构紊乱等。     

无创正压通气在阻塞性睡眠呼吸暂停综合征治疗中的应用

成人睡眠呼吸暂停综合征包括阻塞型睡眠呼吸暂停低通气综合征(OSAHS)、中枢型睡眠呼吸暂停综合征(CSAS)、睡眠低通气综合征(SHS)等,临床上以OSAHS最为常见。OSAHS是指各种原因引起睡眠状态下反复出现呼吸暂停和低通气,夜间反复发生低氧血症、高碳酸血症和睡眠结构紊乱,病情逐渐     

肥胖与阻塞性睡眠呼吸暂停低通气综合征

肥胖患者下颌及咽周脂肪沉积阻塞气道,可导致阻塞性睡眠呼吸暂停低通气综合征(OSAHS),可能作为OSAHS的预测指标.OSAHS是一种由于睡眠期间反复发生上气道塌陷导致睡眠呼吸暂停以及反复低氧的一种疾病,可引起一系列内分泌和代谢异常.OSAHS患者夜间缺氧可导致脂代谢异常、胰岛素敏感性下降、瘦素抵抗,从而在肥胖的发生、发展中起一定作用.     

呼吸暂停低通气指数与夜间缺氧程度不一致的研究

阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者夜间反复发生低氧血症、高碳酸血症，导致心脑血管并发症乃至多脏器损害，严重影响患者的生活质量。多导睡眠监测是诊断OSAHS的金标准，根据睡眠呼吸暂停低通气指数（AHI）和夜间血氧饱和度将OSAHS分为轻、中、重度，以AHI作为主要判断标准，夜间最低血氧饱和度（LSaO2）作为参考。     

血管内皮功能障碍在OSAHS并发高血压发病机制中的作用

阻塞性睡眠呼吸暂停低通气综合征（obstructivesleepapnea．hypopneasyndrome,OSAHS）是一种常见睡眠呼吸疾病,因睡眠期间反复发生上气道部分或完全阻塞引起呼吸暂停和（或）低通气而导致机体间歇性低氧（intemdttenthypoxia,IH）、高碳酸血症和睡眠结构紊乱。临床上以睡眠打鼾、白天嗜睡及夜尿次数增多等为主表现,患者可合并不同程度的多脏器损害,其中心脑血管系统的损害尤为常见。     

肥胖与阻塞性睡眠呼吸暂停低通气综合征心血管并发症临床研究

正阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者睡眠时打鼾伴有呼吸暂停,夜间反复发生低氧血症、高碳酸血症和睡眠结构紊乱,导致心脑血管并发症乃至多器官损害。我国宁夏地区20岁以上常住居民OSAHS患病率为3.31%,上海市30岁以上人群OSAHS患病率为3.62%~([1-2])。肥胖与OSAHS的发病率具有很强的相关性~([3])。本研究比较肥胖组与非肥胖组间OSAHS患者常见心血管并发症的发     

阻塞性睡眠呼吸暂停综合征合并慢性阻塞性肺疾病的研究进展

睡眠呼吸暂停综合征是指各种原因导致睡眠状态下反复出现呼吸暂停和（或）低通气,引起低氧血症、高碳酸血症,使机体发生一系列病理生理改变的临床综合征。其中阻塞性睡眠呼吸暂停综合征（OSAHS）是最常见的类型,患者可合并慢性阻塞性肺疾病（COPD）或其他呼吸系统疾病,如肺囊性纤维化、肺问质纤维化等,也称为重叠综合征（OS）。目前认为,与单纯OSAHS或COPD比较,OS患者与睡眠有关的低氧血症更严重,更易引起肺动脉高压,发展成慢性肺源性心脏病（PHD）。COPD是呼吸衰竭（呼衰）和PHD的最主要原因,     

阻塞性睡眠呼吸暂停低通气综合征诊治指南(草案)

成人睡眠呼吸暂停综合征包括阻塞性睡眠呼吸暂停低通气综合征(OSAHS)、中枢性睡眠呼吸暂停综合征、睡眠低通气综合征等。临床上以OSAHS最为常见，故本指南重点介绍OSAHS。OSAHS主要表现为睡眠时打鼾并伴有呼吸暂停和呼吸表浅，夜间反复发生低氧血症、高碳酸血症和睡眠结构紊乱，导致白天嗜睡、心脑肺血管并发症乃至多脏器损     

氧化应激与睡眠呼吸暂停综合征

睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnen syndrome，OSAHS）是一种常见的呼吸系统疾病，它严重危害人类的健康。OSAHS患者在睡眠过程中，间断上气道阻塞引起反复呼吸暂停、血氧饱和度的下降及组织缺氧，继之发生高通气血氧恢复，这种现象叫做缺氧／再氧合（hypoxia／reoxygenation），     

Ghrelin与阻塞性睡眠呼吸暂停低通气综合征并代谢综合征

Ghrelin是迄今发现的体内唯一的生长激素促分泌物质受体的内源性配体,它不仅是生长激素的强烈促分泌剂,还促进摄食,对调节能量代谢也有重要作用,并可能参与肥胖和2型糖尿病的发病过程,在体内还可以促进机体慢波睡眠,在阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea-hyponea syndrome,OSAHS）患者中尤其明显。本文主要阐述Ghrelin的一般特点及其与OSAHS及代谢综合征的关系。     

Plasma ghrelin levels in patients with short bowel syndrome

Ghrelin is a novel peptide hormone which was identified as an endogenous growth hormone secretagogue. It is mainly secreted in the stomach, but important sites of its secretion are other parts of the gastrointestinal tract. Ghrelin is thought to be involved not only in regulation of growth hormone secretion but also in regulation of food intake and nutritional status. This study was aimed to investigate the changes in plasma ghrelin levels in patients with short bowel syndrome. Twenty-four patients with malnutrition due to short bowel syndrome and eleven healthy controls were included in the study. They underwent clinical examination and assessment of plasma or serum levels of ghrelin leptin, soluble leptin receptor, IGF-I, IGFBP-1 and IGFBP-3. Plasma ghrelin levels were decreased in patients with short bowel syndrome (p<0.01). Furthermore, decreased serum levels of IGF-I (p<0.01) and IGFBP-3 (p<0.001) were found in patients with short bowel syndrome. Other laboratory differences between both groups were not significant. No relationship between ghrelin and other determined variables was found. We conclude that plasma ghrelin levels are decreased in the group of patients with short bowel syndrome. It is probably because of a decrease in the tissue mass that is able to secrete ghrelin.     

Ghrelin与动脉粥样硬化

Ghrelin是近年来发现的一种促进生长激素分泌的多肽,是生长激素促分泌物受体的内源性配体。研究发现,ghrelin除了具有增加摄食及调节能量代谢的作用外,还具有降低血压、对抗炎症反应、保护血管内皮细胞等多种生物学效应,提示其在心血管疾病尤其是在动脉粥样硬化方面具有潜在的治疗效应。     

Plasma ghrelin concentrations are positively associated with carotid artery atherosclerosis in males

BACKGROUND: Ghrelin, a peptide hormone from stomach, stimulates food intake and decreases fat utilization. Ghrelin binds to growth hormone secretagogue receptor (GHSR). GHSR density has been shown to be upregulated in atherosclerotic lesions, but the relationship between ghrelin concentration and atherosclerosis has not yet been studied. We, therefore, characterized the association between ghrelin concentration and carotid artery intima-media thickness (IMT) in a population-based cohort of 1024 middle-aged (40-60 years) men and women. METHODS: Intima-media thickness and the number of atherosclerotic plaques were determined ultrasonographically. Fasting plasma ghrelin concentrations were analysed using RIA-kit (PhoenixPeptide). RESULTS: There was a positive association between mean IMT and ghrelin concentration in the analysis of males before and after adjustments for the traditional risk factors of atherosclerosis [age, systolic blood pressure, LDL cholesterol, body mass index (BMI), and smoking (ancova, P = 0.004 and P = 0.007, respectively)]. However, no such association was found in females (P = 0.985 and P = 0.915). There was no correlation between ghrelin and CRP concentrations or ghrelin and smoking. CONCLUSION: Ghrelin concentrations and carotid artery atherosclerosis are positively associated in males even after adjustment for the commonly recognized risk factors of atherosclerosis. Experimental and prospective studies are warranted to elucidate the role of ghrelin in atherosclerosis.     

Ghrelin在阻塞性睡眠呼吸暂停低通气综合征合并代谢综合征患者中变化及意义

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)合并代谢综合征(metabolic syndrome,MS)患者血浆ghrelin水平的变化及意义.方法 测定OSAHS、MS、OSAHS合并MS患者及正常对照组血浆ghrelin水平并比较其间差异,测定持续气道正压通气治疗前及治疗1周后ghrelin水平并比较其变化.结果 各组血浆ghrelin值分别为:轻度单纯OSAHS组(7例)(56.41±3.99)ng/L,中度单纯OSAHS组(10例)(55.09±5.25)ng/L,重度单纯OSAHS组(19例)(56.28±4.99)ng/L;正常对照组(20名)(63.93±5.27)ng/L;单纯MS组(20例)(55.91±5.37)ng/L;OSAHS合并MS组(14例)治疗前(52.74±2.68)ng/L.治疗后(54.34±3.11)ng/L.单纯OSAHS组、OSAHS合并MS组及单纯MS组的血浆ghrelin水平都较正常对照组降低(P<0.05),OSAHS组间及与单纯MS组间ghrelin水平差异无统计学意义,OSAHS合并MS组持续气道正压通气治疗前后ghrelin水平差异无统计学意义.结论 OSAHS及MS都是一种前炎症状态,其血浆中ghrelin水平均低于正常,ghrelin可能在OSAHS及MS的发生、发展中有重要作用.     

Ghrelin与消化系统的关系研究进展

Ghrelin是新近发现的一种脑肠肽,1999年由日本科学家Kojima从大鼠胃中分离出来,是生长激素促分泌素受体(GHSR)的天然配体,故又称生长素。Ghrelin可调节生长激素(GH)和其他激素的释放,调节能量代谢,抑制肿瘤细胞增殖,影响心血管功能。近来研究发现,Ghrelin与胃动素(motilin)及消化系统关系密切,此文就这方面的研究进展作一综述。     

The role of ghrelin in GH secretion and GH disorders

In humans, growth hormone (GH) is secreted from the anterior pituitary in a pulsatile pattern. The traditional view is that this secretory pattern is driven by two counter regulatory neurohormones, GHRH and somatostatin. Ghrelin, the natural ligand for the growth hormone (GH)-secretagogue receptor (GHS-R), is produced in the stomach. Ghrelin is the strongest GH secretagogue known to date, but the role of endogenous ghrelin in the regulation of circulating GH levels remains controversial. The following review examines the evidence suggesting that endogenous ghrelin may be a key regulator of GH peak amplitude and discusses studies of diseases with altered GH levels, where it is found that in these states GH and ghrelin levels change in a similar way.     

Ghrelin's second life: from appetite stimulator to glucose regulator

Ghrelin, a 28 amino acid peptide hormone produced by the stomach, was the first orexigenic hormone to be discovered from the periphery. The octanoyl modification at Ser3, mediated by ghrelin O-acyltransferase (GOAT), is essential for ghrelin's biological activity. Ghrelin stimulates food intake through binding to its receptor (GRLN-R) on neurons in the arcuate nucleus of the hypothalamus. Ghrelin is widely expressed throughout the body; accordingly, it is implicated in several other physiological functions, which include growth hormone release, gastric emptying, and body weight regulation. Ghrelin and GRLN-R expression are also found in the pancreas, suggesting a local physiological role. Accordingly, several recent studies now point towards an important role for ghrelin and its receptor in the regulation of blood glucose homeostasis, which is the main focus of this review. Several mechanisms of this regulation by ghrelin have been proposed, and one possibility is through the regulation of insulin secretion. Despite some controversy, most studies suggest that ghrelin exerts an inhibitory effect on insulin secretion, resulting in increased circulating glucose levels. Ghrelin may thus be a diabetogenic factor. Obesity-related type 2 diabetes has become an increasingly important health problem, almost reaching epidemic proportions in the world; therefore, antagonists of the ghrelin-GOAT signaling pathway, which will tackle both energy- and glucose homeostasis, may be considered as promising new therapies for this disease.     

Role of endogenous ghrelin in growth hormone secretion, appetite regulation and metabolism

Ghrelin, a 28-amino acid hormone that is acylated post-translation, is the endogenous ligand for the growth hormone (GH) secretagogue (GHS) receptor (GHS-R). The highest concentrations of ghrelin are found in the stomach; however ghrelin peptide is also present in hypothalamic nuclei known to be important in the control of GH and feeding behavior. Exogenous ghrelin potently stimulates pituitary GH release through a mechanism that is dependent, in part, on endogenous GH-releasing hormone. Whether endogenous ghrelin plays a role in the control of GH secretion and growth is not clear and ghrelin deficient animals appear to grow normally. In contrast, experimental animal and clinical data suggest that abnormalities in GHS-R signaling could impact growth. Ghrelin or other GHS are clinically useful for GH-testing and limited data suggest that they might be useful in the treatment of some patients with GH deficiency. Substantial data have implicated ghrelin as an important regulator of feeding behavior and energy equilibrium. Ghrelin has a potent orexigenic effect in both animals and humans and this effect is mediated through hypothalamic neuropeptide Y (NPY) and Agouti-related peptide (AgRP). Appetite simulation coupled with other metabolic effects promotes weight gain during chronic treatment with ghrelin. These metabolic effects are in part mediated through an increase in respiratory quotient (VQ). Presence of ghrelin appears to be necessary for the development of obesity in some animal models. Whether abnormalities in ghrelin signaling are involved in human obesity is not yet known.     

Ghrelin与慢性心力衰竭

Ghrelin是近年来发现的一种肽类激素,是生长激素促泌物受体(GHS-R)的内源性配体。Ghrelin除了刺激生长激素分泌外,还具有许多其他的生理作用。研究发现:在心血管疾病特别是慢性心力衰竭的治疗方面具有潜在的功效。