睡眠呼吸暂停综合征患者外周血中部分血管活性物质的变化

背景睡眠呼吸暂停综合征可诱发或加重多种心血管疾病的发生发展,该种作用的发生可能与许多血管活性物质有关.目的观察不同程度睡眠呼吸暂停综合征患者部分血管活性物质内皮素1、血管紧张素Ⅱ、血栓烷素B2、6-酮-前列腺素F1α、降钙素基因相关肽的变化及其相关性.设计病例-对照,对比观察.单位解放军总医院心内科及老年心血管病研究所.对象选择1999-10/2001-09解放军总医院老年心血管病研究所并疑似为睡眠呼吸暂停综合征患者37例,男32例,女5例;年龄35～75岁,平均(56±11)岁.所有患者对实验目的均知情,并同意配合.方法①应用多导睡眠监测仪进行睡眠监测,记录并分析多导睡眠图.以呼吸暂停指数或呼吸紊乱指数为睡眠呼吸障碍的主要诊断指标.呼吸暂停指数为每小时呼吸暂停的次数,呼吸紊乱指数=[(睡眠呼吸暂停次数+低通所次数)/睡眠时间(min)]×60.根据呼吸紊乱指数将患者分为4组呼吸紊乱指数≤5为正常组6例,5＜呼吸紊乱指数≤20为轻度睡眠呼吸暂停综合征组7例,20＜呼吸紊乱指数≤40为中度睡眠呼吸暂停综合征组13例,呼吸紊乱指数＞40为重度睡眠呼吸暂停综合征组11例.②血清内皮素1、血管紧张素Ⅱ、血栓烷素B2、6-酮-前列腺素F1α、降钙素基因相关肽水平测定均采用均相竞争放射免疫分析法测定.③计量资料均数间的比较采用单因素方差分析,计数资料的比较采用x2检验,参数的相关性采用Person相关分析.主要观察指标①不同程度睡眠呼吸暂停综合征患者血清内皮素1、血管紧张素Ⅱ、血栓烷素B2、6-酮-前列腺素F1α、降钙素基因相关肽水平比较.②血管活性物质与呼吸暂停参数相关性.结果疑似睡眠呼吸暂停综合征患者37例均进入结果分析.①重度睡眠呼吸暂停综合征组的血栓烷素B2和内皮素1水平显著高于正常组[(333.60±52.87),(56.64±21.96)ng/L;(230.91±21.65),(28.45±7.76)ng/L,P＜0.05],中重度睡眠呼吸暂停综合征组血清中血管紧张素Ⅱ水平显著高于正常组[(187.31±69.95),(594.84±49.38),(42.05±14.56)ng,P＜0.05,0.01].②呼吸暂停指数、呼吸紊乱指数与血中内皮素1,血管紧张素Ⅱ水平呈显著正相关(r=0.335～0.594,P＜0.05),而与6-酮-前列腺素F1α、降钙素基因相关肽水平无显著相关性(P＞0.05).结论睡眠呼吸暂停可引起具有血管收缩功能的血管活性物质内皮素1和血管紧张素Ⅱ水平及凝血物质血栓烷素B2水平上升,但对具有强烈血管舒张作用及抗血小板聚集的物质降钙素基因相关肽和6-酮-前列腺素F1α无影响.

Changes of some active cardiovascular substances in peripheral blood of patients with sleep apnea syndrome

BACKGROUND:Sleep apnea syndrome can cause or aggravate many cardiovascular diseases, and may be associated with many vascular active materials.OBJECTIVE: To observe the changes of some vascular active materials,such as endothelium-1 (ET-1), angiotensin Ⅱ (Ang Ⅱ ),Thromboxane B2(TXB2), 6-keto-prostagladin F-1 alpha (PGF-1α), calcitonin gene related protein(CGRP) in various severity of sleep apnea syndrome and their relativity.DESIGN: A case-control trial.SETTING: The Department of Cardiology and the Institute of Geriatric Cardiovascular Disease, General Hospital of Chinese PLA.PARTICIPANTS: From October 1999 to September 2001, thirty-seven patients being suspicious of having sleep apnea syndrome, hospitalized in the Institute of Geriatric Cardiovascular Disease of the General Hospital of Chinese PLA, including 32 men and 5 women at the age of 35-75 years with average 56±11 years, agreed to participate in the study voluntarily,were recruited in the study.METHODS: Subjects underwent polysomnography (PSG) test, and apnea index(AI) and respiratory disturbance index(RDI) were recorded. AI means the number of apneas per hour, and the formula of RDI is as follows: RDI=[(total number of apneas +total number of hypopneas)/sleeping time(min)]×60. According to RDI, subjects were divided into four groups: normal group (RDI ≤5, n=6), mild group (5＜RDI≤20, n=7), moderate group (20＜RDI≤40, n=13), and severe group(RDI＞40, n=11). The levels of ET-1, AngⅡ,TXB2,6-keto-PGF1α, CGRP in the blood were examined by means of radioimmunology assay. One-way analysis of variance and Chi-square test were conducted for comparison of measurement data and enumeration data,respectively; Person correlation analysis was adopted to determine the correlativity among parameters,P ＜ 0.05 was taken as significance.MAIN OUTCOME MEASURES: Levels of ET-1, Ang Ⅱ, TXB2,6-ketoPGF1α, CGRP in the blood in the patients with sleep apnea syndrome of different degree, and correlativity between vasoactive substances and apnea parameters.RESULTS: All the 37 patients being suspicious of having sleep apnea 1 in the severe group were (333.60±52.87) and (56.64±21.96)ng/L, significantly higher than (230.91±21.65) and (28.45±7.76)ng/L in the normal group, respectively (P ＜ 0.05). The level of AngⅡ in the moderate and severe groups were (187.31±69.95) and (594.84±49.38) ng/L, separately, which was significantly higher than that in the normal group cantly and positively correlated to ET-1, AngⅡ and TXB2 (P ＜ 0.05), but had no correlation with 6-keto-PGFlα and CGRP level(P ＞ 0.05).CONCLUSION: Sleep apnea can result in increase in the levels of some vasoactive substances with vasoconstrictive activity, such as ET-1, Ang Ⅱ,and TXB2, however, has no influence on 6-keto-PGF1α and CGRP levels that play a role in vasodilatation and against platelet aggregation.