阻塞性睡眠呼吸暂停低通气综合征患者血浆硫化氢的变化及临床意义

目的：探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血浆硫化氢(H2S)水平的变化及其临床意义。方法选取2011年1月至2015年1月我院呼吸科门诊和住院经多导睡眠仪(PSG)监测符合OSAHS的患者86例，其中轻度组25例，中度组32例，重度组29例，同期门诊体检健康者28例为对照组。四组入选者均在PSG监测次日晨醒后测定空腹血浆H2S水平，比较各组血浆H2S水平并分析其与PSG监测指标呼吸暂停低通气指数(AHI)、最低血氧饱和度(LSpO2)的关系。结果轻度组患者血浆H2S水平为(41.23±1.63)μmol/L，与对照组的(42.12±2.11)μmol/L比较差异无统计学意义(P>0.05)，但中、重度组患者血浆H2S水平(34.61±1.79)μmol/L]和(31.71±2.01)μmol/L]与对照组比较差异均有统计学意义(P<0.01)；轻、中、重度三组患者血浆H2S水平呈逐渐下降，差异均具有统计学意义(P<0.01)；血浆H2S水平与AHI呈负相关(轻度组：r=-0.285，P=0.026；中度组：r=-0.384，P=0.0021；重度组：r=-0.422，P=0.0065)，与LSpO2呈正相关(轻度组：r=0.395，P=0.0023；中度组：r=0.422，r=0.0021；重度组：r=0.483，P=0.001)。结论 OSAHS患者血浆H2S水平下降，不仅和疾病严重程度相关，还和夜间缺氧程度有关，临床上血浆H2S可作为评估OSAHS患者病情严重程度的一个方便简易监测指标。

Clinical significance of the changes of plasma hydrogen sulfide levels in patients with obstructive sleep apnea hypopnea syndrome

Objective To investigate the changes of plasma hydrogen sulfide (H2S) and its clinical significance in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods A total of 86 patients with OSAHS, who admitted to Department of Respiratory of our hospital from January 2011 to January 2015 and checked with polysom-nography (PSG), were selected as the research objects and divided into the mild group (n=25), the moderate group (n=32) and the severe group (n=29). Meantime, 28 cases of healthy volunteers were chosen as the control group. The fasting plas-ma H2S level of these 4 groups were measured and compared at the next day after PSG monitoring, and the relationship be-tween level and apnea-hypopnea index (AHI) and lowest oxygen saturation (LSpO2) were analyzed. Results There was no significant difference between the mild group (41.23±1.63)μmol/L and the control group (42.12±2.11)μmol/L in theplasma H2S level (P>0.05). However, the plasma H2S level of the severe group (34.61±1.79)μmol/L and moderate group (31.71 ± 2.01)μmol/L were significantly lower than that of the control group (P<0.01). The plasma H2S levels of three groups (mild, moderate and severe) were gradually decreased, and the differences were statistically significant (P<0.01). There was a negative correlation between plasma H2S levels and AHI (mild group:r=-0.285, P=0.026;moderate group:r=-0.384, P=0.0021;severe group:r=-0.422, P=0.006 5);there was a positive correlation between plasma H2S levels and LSpO2 (mild group:r=0.395, P=0.002 3;moderate group:r=0.422, P=0.002 1;severe group:r=0.483, P=0.001). Conclusion The decrease of the levels of plasma endogenous H2S in patients with OSAHS is not only related to the se-verity of the disease, but also to the degree of hypoxia in the night. The decrease of endogenous H2S may affect the inci-dence of OSAHS, which can be used as a monitoring index of OSAHS severity.