阻塞性睡眠呼吸暂停低通气综合征患者呼出气冷凝液中白细胞介素6的研究

目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者是否存在夜间呼吸事件相关的呼吸道炎症反应。方法对31例OSAHS患者(分为OSAHS吸烟组15例和非吸烟组16例)和10名健康对照者(健康对照组)采用自行设计的呼出气冷凝液(EBC)收集器收集晨起即刻和睡前的EBC,应用酶联免疫技术测定EBC中白细胞介素6(IL6)的含量,并进行统计学分析。结果(1)睡前IL6水平OSAHS吸烟组(2.5±1.0)ng/L]、非吸烟组(2.3±0.8)ng/L]、健康对照组(2.7±1.0)ng/L]比较差异无统计学意义(F=0.515,P>0.05)。晨起IL6水平OSAHS吸烟组(3.7±1.9)ng/L]和非吸烟组(3.1±1.2)ng/L]均高于健康对照组(2.0±0.8)ng/L],差异有统计学意义(P<0.05);吸烟组和非吸烟组比较差异无统计学意义(P>0.05)。(2)晨起IL6水平OSAHS吸烟组和非吸烟组均较睡前显著增高(P<0.05);而健康对照组晨起IL6水平较睡前降低,差异有统计学意义(P<0.05)。(3)晨起IL6的浓度与呼吸暂停低通气指数(AHI)、氧减饱和指数(ODI4)呈正相关(r值分别为0.441、0.533,P均<0.05),与夜间最低血氧饱和度(LSaO2)呈负相关(r=-0.529,P<0.05)。结论EBC中IL6水平的高低与病情严重程度有关,故可作为OSAHS气道炎症反应的一项重要监测指标。

The interleukin-6 level in exhaled breath condensate of patients with obstructive sleep apnea-hypopnea syndrome

OBJECTIVE: To explore whether the airway inflammation marker in exhaled breath condensate is increased in obstructive sleep apnea-hypopnea syndrome (OSAHS). METHODS: Thirty-one patients with OSAHS (15 smokers and 16 non-smokers) and 10 healthy age-matched and weight-matched controls were included in the study. Exhaled breath condensate (EBC) was collected before and after sleep at the same night from both groups. Interleukin-6 (IL-6) in EBC was measured by a specific enzyme immunoassay. RESULTS: (1) There was no difference in the pre-sleep IL-6 level among OSAHS smoker group, OSAHS non-smoker group and the control subjects (F = 0.515, P > 0.05). Compared with the level of pre-sleep (2.5 +/- 1.0) ng/L in OSAHS smoker, and (2.3 +/- 0.8) ng/L in OSAHS non-smoker], the post-sleep level of IL-6 was elevated significantly in EBC from OSAHS patients of non-smokers (3.1 +/- 1.2) ng/L] and smokers (3.7 +/- 1.9) ng/L, P < 0.05]. Nevertheless, IL-6 level from the control group showed a reverse change. IL-6 was decreased significantly (2.0 +/- 0.8) ng/L in pre-sleep vs (2.7 +/- 1.0) ng/L in post-sleep] after sleep in this group. There was no difference in post-sleep IL-6 level between OSAHS smokers (3.7 +/- 1.9) ng/L] and non-smokers (3.1 +/- 1.2) ng/L, P > 0.05]. A significant higher IL-6 level was observed in both OSAHS smokers (3.7 +/- 1.9) ng/L] and non-smokers (3.1 +/- 1.2) ng/L] compared with the controlled group (2.0 +/- 0.8) ng/L, P < 0.05]. IL-6 level in EBC was correlated positively with AHI (r = 0.441, P < 0.05), ODI(4) (r = 0.533, P < 0.05), and negatively with minimal oxygen saturation (r = -0.529, P < 0.05). CONCLUSIONS: These findings suggest that inflammation was characteristic in the airways of OSAHS patients. Nocturnal hypoxia could be responsible for this change. The levels of IL-6 in EBC are associated with the severity of OSAHS and may prove to be useful in monitoring of airway inflammation in OSAHS.