阻塞性睡眠呼吸暂停低通气综合征患者血浆白细胞介素-18水平与动脉粥样硬化的关系

目的 探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血浆IL-18水平与动脉粥样硬化的关系.方法 选取就诊的男性OSAHS患者52例,年龄26～77岁,分为轻度组16例,中度组18例,重度组18例,另选对照组18例.对其中OSAHS组中20例中重度患者进行持续气道内正压(CPAP)治疗,并检测颈动脉内膜中膜厚度(IMT),测定血浆白细胞介素-18(IL-18)的水平.采用方差分析、配对t检验及Pearson相关分析进行统计学处理.结果 轻度、中度和重度OSAHS组的IL-18水平分别为(352±76)ng/L、(600±84)ng/L和(798±110)ng/L,均明显高于对照组的(250±76)ng/L,且OSAHS各组间均有明显差别.重度OSAHS组颈动脉IMT较对照组和轻度OSAHS组明显增厚.血浆IL-18水平与颈动脉IMT、呼吸暂停低通气指数(AHI)呈显著正相关(r值分别为0.486、0.865,P均＜0.001),与最低脉搏氧饱和度呈显著负相关(r=-0.664,P＜0.001).CPAP治疗后OSAHS患者血浆IL-18水平明显降低,颈动脉IMT未见明显改变.结论 OSAHS患者颈动脉IMT增厚,血浆IL-18水平升高,两者密切相关.血浆IL-18水平升高与OSAHS严重程度相关,OSAHS相关炎症反应可能与动脉粥样硬化的进程相关.CPAP治疗能够改善患者AHI和最低脉搏氧饱和度,降低血浆IL-18水平.

Association between plasma interleukin-18 levels and atherosclerosis in patients with sleep apnea hypopnea syndrome

OBJECTIVE: To investigate the association between plasma interleukin-18 (IL-18) levels and atherosclerosis in patients with obstructive obstructive sleep apnea hypopnea syndrome (OSAHS). METHODS: Based on apnea hypopnea index (AHI) during sleep monitored by polysomnography, 52 male patients with OSAHS were recruited and divided into a mild OSAHS group (n = 16), a moderate group (n = 18), and a severe group (n = 18). Eighteen healthy subjects were selected as the control group. Twenty patients with moderate-to-severe OSAHS underwent continuous positive airway pressure (CPAP) treatment. HDL5000 color Doppler ultrasound was used to measure intima-media thickness (IMT) of the jugular arteries. Plasma IL-18 levels were measured by ELISA. Analysis of variance, paired-samples T test and Pearson correlation analysis were used for statistics. RESULTS: Compared with the plasma IL-18 levels in the control group (250 +/- 76) ng/L], there was a significant increase in the mild OSAHS group (352 +/- 76) ng/L], moderate group (600 +/- 84) ng/L], and severe OSAHS group (798 +/- 110) ng/L (all P < 0.01)]. Moreover, there was a significant difference in plasma IL-18 levels among three OSAHS groups (P < 0.01). The jugular arterial IMT was significantly greater in severe OSAHS group than that in mild OSAHS group (P < 0.01). The plasma IL-18 levels were positively correlated with jugular arterial IMT (r = 0.486, P < 0.001) and with AHI (r = 0.865, P < 0.001) respectively. After CPAP treatment, plasma IL-18 levels were significantly decreased but the jugular arterial IMT did not change significantly. CONCLUSION: Our study demonstrated that jugular arterial IMT and plasma IL-18 levels were significantly increased and closely correlated. The elevation of plasma IL-18 levels was correlated with the severity (AHI and miniSaO(2)) of OSAHS.