阻塞性睡眠呼吸暂停低通气综合征患者血小板活化和纤溶活性的研究

目的　探讨血小板活化、凝血激活和继发纤溶亢进在阻塞性睡眠呼吸暂停低通气综合征 (OSAHS)发生发展中的作用及经鼻持续气道正压通气 (nCPAP)对其影响。方法　选择经多导睡眠图 (PSG)确诊的OSAHS患者 5 8例为实验组 ,根据睡眠呼吸暂停低通气指数 (AHI)、最低血氧饱和度(SaO2 min)将OSAHS患者分轻、中、重组 ,并设正常对照组 2 0例 ,11例重度OSAHS患者接受nCPAP治疗为治疗组 ,用酶联免疫双抗体夹心法检测各组血浆α 颗粒膜蛋白 (GMP 14 0 )、血小板膜糖蛋白Ⅱb/Ⅲa(GPⅡb/Ⅲa)和D 二聚体 ,比较各实验组与对照组 ,治疗组治疗前后的各项指标的差异。　结果(1)中、重度OSAHS患者组血浆GMP 14 0、GPⅡb/Ⅲa和D 二聚体均显著高于对照组 (P <0 .0 5 ) ,nCPAP治疗后比治疗前明显下降 (P <0 .0 0 1) ;(2 )GMP 14 0、GPⅡb/Ⅲa和D 二聚体与AHI呈正相关 ,与最低SaO2 呈负相关 (P <0 .0 0 1)。结论　中、重度OSAHS患者存在血小板活化、凝血激活和继发纤溶亢进 ,其在OSAHS患者心脑血管栓塞性并发症高发病率中起重要作用 ,并与夜间低氧血症密切相关 ;nCPAP治疗可有效逆转上述改变。

Significance of the changes of platelet activation and fibrinolytic activity in patients with obstructive sleep apnea*!-hypopnea syndrome

OBJECTIVE: To investigate the changes of platelet activation, coagulability, and fibrinolytic activation in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) before and after the institution of nasal continuous positive airway pressure (nCPAP). METHODS: Fifty-eight cases of OSAHS confirmed by polysomnography (PSG) were selected as the trial group, 20 subjects without OSAHS were recruited as the control group. Eleven patients with severe OSAHS were treated by nCPAP. Plasma GMP-140, GPIIb/IIIa and D-dimer were measured by ELISA. RESULTS: Plasma levels of GMP-140, GPIIb/IIIa and D-dimer were significantly higher in patients with moderate to severe OSAHS than those in the control group, P < 0.05, and nCPAP therapy decreased their levels significantly, P < 0.001. GMP-140, GPIIb/IIIa and D-dimer were correlated positively with AHI, and negatively with minimal oxygen saturation, P < 0.001. CONCLUSIONS: Our findings suggest that activation of platelet and coagulation system with fibrinolytic activation may be associated with the high prevalence of cerebrovascular and cardiovascular events in patients with OSAHS. nCPAP therapy is effective in correcting these coagulatory and fibrinolytic abnormalities.