血浆同型半胱氨酸在阻塞性睡眠呼吸暂停低通气综合征并心血管疾病中的意义探讨

目的 初步探讨同型半胱氨酸(HCY)在阻塞性睡眠呼吸暂停低通气综合征(OSAHS)并心血管疾病(CVD)中的意义.方法 单纯鼾症组15例、单纯OSAHS组42例及OSAHS合并CVD组37例.行睡眠呼吸监测,检测血浆HCY、血脂.OSAHS组30例、OSAHS+CVD组24例进行nCPAP治疗,3个月后比较两组治疗前后睡眠呼吸紊乱、HCY水平变化.结果 ①单纯鼾症组、OSAHS组、OSAHS+CVD组HCY值渐升高,P<0.05.各组间TC、TG、VLDL水平不同,但两两比较差异不全有意义.②相关分析显示AHI及RIT与HCY关系最密切,相关系数r分别为0.899、0.835.③经nCPAP治疗后,OSAHS组、OSAHS+CVD组睡眠呼吸紊乱得到改善,血浆HCY浓度较治疗前下降,P<0.05.结论 OSAHS患者HCY水平升高,HCY可能进一步参与心血管疾病的发生发展过程.nCPAP治疗可降低HCY水平.

Study on plasma homocysteine and obstructive sleep apnea-hypopnea syndrome with cardiovascular diseases

Objective The purpose of this study was to investigate the roles of plasma homocysteine ( HCY) in physiopathologic process of obstructive sleep apnea-hypopnea syndrome (OSAHS) with cardiovascular diseases (CVD). Methods Following polysomnographic examination, 94 habitual snorers were divided into 3 groups: 15 simple snorers,42 simple OSAHS and 37 OSAHS with CVD. Plasma concentrations of HCY and Lipid were measured. 30 OSAHS patients and 24 OSAHS with CVD patients accepted nasal continuous positive airway pressure (nCPAP) therapy for 3 month, then polysomnography and HCY were measured again. Results ①HCY concentrations gradually increase among simply snorers,OSAHS group and OSAHS+CVD group,and the differences were significant. The concentrations of TC,TG and VLDL also were different in 3 groups,but no entirely significant difference among groups. ②Stepwise multiple regression analysis showed that AHI and RIT were independently associated with serum homocysteine levels (the rseparately is 0.899,0.835). ③After nCPAP therapy, sleep disorder improved in OSAHS and OSAHS + CVD groups, and HCY concentrations decrease significantly. Conclusions Patients with OSAHS had higher plasma HCY levels than simply snorers.Homocysteine may contribute to physiopathologic process of cardiovascular diseases in OSAHS patients. Effective nCPAP therapy can decrease HCY concentrations both in OSAHS and OSAHS+CVD groups.