阻塞性睡眠呼吸暂停低通气综合征患者氧化-抗氧化状态及夜间无创通气的干预作用

目的探讨阻塞性睡眠呼吸暂停低通气综合征患者氧化-抗氧化状态及夜间无创通气的干预作用。方法对34例阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者监测睡眠呼吸暂停低通气指数（AHI）、睡眠平均氧饱和度（MSaO，）、睡眠平均最低氧饱和度（MMSaO2）、夜间基础与最低氧饱和度之差（△SaO2），并在夜间睡前、晨起及夜间持续无创气道正压通气（NIPPV）治疗3周后晨起测定其血清8-异前列腺素F2α（8-iso—PGF2α）、超氧化物歧化酶（SOD）、内二醛（MDA）、总抗氧化能力（T—AOC），并与30例健康对照者比较。结果与对照组比较，OSAHS组睡前血清8-isoPGF2α、MDA显著升高，SOD、T—AOC显著降低（均P〈0．01）。在OSAHS患者中，晨起血清8-isoPGF2α、MDA水平显著高于，SOD、T—AOC水平显著低于睡前（均P〈0．01）。AHI、△SaO2与晨起血清8-isoPGF2α、MDA湿著正相关（分别r=0．539、0．633和0．702、0．657，均P〈0．01），与SOD、T—AOC显著负相关（分别r=-0．597、-0．614和-0．672、-0．688，均P〈0．01）；MSa02、MMSaO，与晨起血清8-isoPGF2α、MDA显著负相关（分别r=-0．623、-0．605和-0．592、-0．560，均P〈0．01），与SOD、T—AOC显著正相关（分别r=0．582、0．705和0．681、0．621，均P〈0．01）。OSAHS组与治疗前晨起比较，NIPPV治疗3周后晨起血清8-isoPGF2α、MDA水平显著降低，SOD、T—AOC水平显著升高（均P〈0．01）。结论OSAHS患者存在持续性氧化应激状态，而这种表现晨起较睡前严重，且随着病情的加重而加重。NIPPV能有效地改善OSAHS患者氧化-抗氧化失衡状态。

State of oxidation-antioxidation and interfering effects of noninvasive positive pressure ventilation in patients with obstructive sleep apnea hypopnea syndrome

Objective To investigate the state of oxidation-antioxidation and interfering effects of noninvasive positive pressure ventilation in patients with obstructive sleep apnea bypopnea syndrome （OSAHS）. Methods The apnea-hypopnea index （AHI）, sleep mean arterial oxygen saturation （MSaO2 ）, sleep mean minimum arterial oxygen saturation （MMSaO2 ） and difference between basic and minimum SaO2 （△SaO2） during sleep were detected in 34 patients with OSAHS. 8-iso-prostaglaudin F2α （ 8-iso-PGF2α ）, superoxide dismutase （ SOD ）, malondialdehyde （ MDA ） and total antioxidant apacity （T-AOC） were measured befor sleep, during morning get up, and during morning get up after treatmented 3 weeks by noninvasive positive pressure ventilation （NIPPV） in all of patients, and 30 healthy volunteers served as control. Results Compared with control group, the level of serum 8-iso-PGF2α and MDA were markedly increased, SOD and T-AOC were markedly decreased before sleep of the OSAHS group （ all P 〈 0. 01 ）. In patirnts with OSAHS, level of serum 8-iso-PGF2α and MDA were markedly higher, SOD and T-AOC were markedly lower during morning get up than those of before sleep （ all P 〈 0.01 ）. Correlation analysis showed AHI and A SaO2 were markedly positive correlated with levels of serum 8-iso-PGF2α and MDA during morning get up （r = 0. 539, 0. 633 and 0. 702, 0. 657, respectively, all P 〈 0.01 ） ,markedly negative correlated with level of serum SOD and T-AOC （r = - 0. 597, - 0. 614 and - 0. 672, - 0. 688, respectively, all P 〈 0.01 ）, MSaO2 and MMSaO2 were markedly negative correlated with levels of serum 8-iso-PGF2α and MDA during morning get up （ r = - 0. 623, -0. 605 and- 0. 592, -0. 560, respectively, all P 〈 0.01 ）, markedly positive correlated with level of serum SOD and T-AOC （ r = 0. 582, 0. 705 and 0. 681, 0. 621, respectively, all P 〈 0.01）. Compared with during morning get up before treatment, level of serum 8-iso-PGF2α and MDA were markedly dicreased, SOD and T-AOC were markedly increased during morning get up after 3 weeks by NIPPV treatment. Conclusion The oxidative stress is occured in patients with OSAHS, which is more severe during morning get up than before sleep, and it is aggravated along with the disease worsens. NIPPV treatment can effectively improved oxidative-antioxidative imbalance in patients with OSAHS.