阻塞性睡眠呼吸暂停低通气综合征患者肝功能损害研究

目的 探讨中、重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血清丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、胆固醇(TC)、甘油三酯(TG)、血管内皮生长因子(VEGF)及部分患者经鼻持续正压通气(nCPAP)治疗后的变化及意义.方法 研究经多导睡眠监测仪(PSG)确诊的59例OSAHS患者及28例健康对照血清ALT、AST、TC、TG、VEGF水平及13例经nCPAP治疗后的患者血清VEGF水平,并监测患者呼吸紊乱指数(AHI)、血氧饱和度《90%的时间(SIT90)、平均血氧饱和度(MSaO2)、最低血氧饱和度(LSaO2)等睡眠指标.结果 OSAHS患者根据AHI分为中、重两组.健康对照组与OSAHS中度、重度组比较血清ALT、AST、TC、TG、VEGF水平,差异均有统计学意义(P均《0.01).OSAHS患者其血清ALT、AST水平与MSaO2呈负相关,与VEGF呈正相关(相关系数分别为-0.137,-0.245,0.101,0.115,P均《0.01).13例重度OSAHS患者nCPAP治疗3个月后血清ALT(37±7)U/L、AST(24±5)U/L、TC(1.51±0.14)mmo/L、VEGF水平(520±90)ng/L,治疗前ALT(65±18)U/L、AST(52±4)U/L、TC(1.82±0.12)mmol/L、VEGF(704±93)ng/L,治疗前后差异有统计学意义(P《0.01).结论 OSAHS患者夜间反复低氧血症可能影响肝脏功能从而引起ALT、AST,TC、TG血清水平升高,经nCPAP治疗后,血清ALT、AST、TC水平下降亦证实反复低氧参与肝脏功能损害.

Change and significance of the serum levels of liver enzymes in obstructive sleep apnea hypopnea syndrome patients

Objective To study the serum levels of liver enzymes with obstructive sleep apnea hypopnea syndrome(OSAHS) and some patients with nasal continuous positive air pressure(nCPAP) treatment.Methods Fifty-nine OSAHS patients were confirmed by polysomnogrophy(PSG),twenty-eight healthy subjects were recruited as the control group.Thirteen patients with OSAHS were treated by nCPAP,the serum levels of liver enzymes and VEGF were measured in all patients.Sleeping items such as apnea hypopnea index(AHI),proportion of SaO2<90% sleep time in total sleep time(SIT90),mean SaO2(MSaO2),lowest SaO2(LSaO2)and others were observed in the patients.Results OSAHS patients were divided into two groups according to AHI.The serum levels of liver enzymes and VEGF in the above three groups increased more significantly in contrast to that of the healthy control group(all P<0.01).Serum ALT,AST level correlated negatively with MSaO2,positively with VEGF level (r=-0.137,-0.245,0.101,0.115,all P<0.01).After nCPAP treatment in the thirteen OSAHS patients for three months,the serum levels of liver enzymes and VEGF,showing statistical significance(P<0.01).Conclusion Nocturnal recurrent hypoxia results in higher the serum levels of liver enzymes and VEGF,severe OSAHS is a risk factor for chronic liver injury.