阻塞性睡眠呼吸暂停低通气综合征患儿黏附分子水平的变化及临床意义

目的探讨阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)儿童血浆黏附分子水平的变化及意义。方法选择2009年1月～2011年6月在新疆医科大学第一附属医院诊治的95例OSAHS患儿,并选取同期健康儿童46例作为对照。检测P-选择素(P-se-lectin)和细胞间黏附分子-1(ICAM-1),测定各组儿童身高、体重及多导睡眠监测(polysomnogram,PSG)。结果重度OSAHS组的P-selectin浓度值为(127.2±56.3)ng/ml,中度OSAHS组为(91.5±37.8)ng/ml,轻度OSAHS组为(88.2±45.7)ng/ml;对照组为(54.5±30.3)ng/ml,4组比较差异具有统计学意义(F=4.26,P<0.05)。4组血浆ICAM-1浓度值比较,差异无统计学意义(F=1.13,P>0.05),肥胖儿童的ICAM-1浓度值高于非肥胖儿童[(223.4±46.4)ng/ml vs(137.2±78.9)ng/ml],两组比较差异具有统计学意义(t=3.041,P<0.05);P-selection与呼吸暂停低通气指数(AHI)、呼吸觉醒指数(RAI)呈正相关(分别为r=0.28,P<0.05;r=0.19,P<0.05);与指脉氧饱和度(SpO2nadir)呈负相关(r=-0.26,P<0.05)。结论 P-selection在轻、中、重度OSAHS患儿中升高,提示OSAHS能诱发炎性反应的产生,增加儿童患心血管疾患的危险性。ICAM-1升高的因素主要归因于肥胖而非OSAHS。

Changes of plasma levels of adhesion molecules in children with obstructive sleep apnea hypopnea syndrome and the clinical significance

Objective To explore the changes of plasma levels of adhesion molecules in children with obstructive sleep apnea hypopnea syndrome(OSAHS) and the clinical significance.Methods Ninety-five children with OSAHS in the First Affiliated Hospital of Xinjiang Medical University from Jan.2009 to Jun.2011 were selected for the study.Forty-six children were selected as healthy controls.Plasma levels of intercellular adhesion molecule(ICAM)-1 and P-selectin were measured by enzyme-linked immunosorbent assay.Height,weight were measured and body mass index(BMI) was calculated in these subjects.Polysomnography was performed.Results The P-selectin levels in the severe OSAHS group(127.2±56.3 ng/ml) and moderate OSAHS group(91.5±37.8 ng/ml) were significantly higher than that of the control group(54.5±30.3 ng/mL)(F=4.26,P<0.05).The differences of ICAM-1 levels among above-mentioned groups were statistically insignificant.However,the ICAM-1 level of obese children(223.4±46.4 ng/ml) was significantly higher than that of non-obese ones(137.2±78.9 ng/ml)(t=3.041,P<0.05).Furthermore,the level of P-selectin was related positively with apnea hypopnea index(r=0.28,P<0.05),respiratory arousal index(r=0.19,P<0.05) and negatively with nadir of oxygen saturation as measured by pulse oximetry(r=-0.26,P<0.05).Conclusion Children with moderate to severe OSAHS have plasma elevations of P-selectin,a marker of platelet activation,suggesting that inflammatory processes may be elicited by OSAHS in children,and may contribute to accelerated risk for cardiovascular morbidity.In contrast,elevations in ICAM-1 are primarily associated with obesity rather than OSAHS.