不同程度老年阻塞性睡眠呼吸暂停低通气综合征患者髓过氧化物酶和胰淀素水平分析

Analysis of myeloperoxidase and amylin in elderly obstructive sleep apnea hypopnea syndrome patients with different severities

摘要:

目的 研究不同程度老年阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血清髓过氧化物酶(MPO)和胰淀素水平变化及意义。方法 回顾性分析2012年2月至2016年10月成都市第六人民医院耳鼻咽喉科收治的老年OSAHS患者134例,根据呼吸暂停低通气指数(AHI)分为重度组55例、中度组41例和轻度组38例。比较3组患者多导睡眠监测(PSG)指标及MPO和胰淀素水平,Spearman相关法分析胰淀素及MPO的影响因素。应用SPSS 13.0统计软件对数据进行分析。依据数据类型采用方差分析或χ²检验进行组间比较。结果 相比重度组患者,轻度组和中度组患者AHI、氧减指数(ODI)、呼吸暂停和低通气次数显著降低,夜间最低血氧饱和度(LSaO₂)和平均动脉血氧饱和度(MSaO₂)水平显著升高,差异均具有统计学意义(P＜0.05)。重度组持续气道正压通气治疗前相比轻度组和中度组患者血清胰淀素[(47.85±6.41)和(20.29±3.06)ng/ml；(47.85±6.41)和(31.57±5.27)ng/ml]和MPO[(37.92±9.88)和(7.61±2.04)ng/mg；(37.92±9.88)和(23.33±4.56)ng/mg]水平高,差异均具有统计学意义(P＜0.05)。重度组患者持续气道正压通气治疗6个月及1年后相比治疗前血清胰淀素[(34.17±4.96)和(47.85±6.41)ng/ml；(27.14±3.86)和(47.85±6.41)ng/ml]和MPO[(21.06±8.39)和(37.92±9.88)ng/mg；(12.17±7.53)和(37.92±9.88)ng/mg]水平显著降低,差异均具有统计学意义(P＜0.05)。Spearman相关分析结果表明MPO和胰淀素水平与LSaO₂、MSaO₂负相关,与AHI、呼吸暂停次数正相关。结论 血胰淀素和MPO水平测定对老年OSAHS患者并发胰岛素抵抗危险及持续气道正压通气治疗效果评估具有参考价值。

Abstract:

Objective To study the changes of serum myeloperoxidase (MPO) and amylin levels in elderly obstructive sleep apnea hypopnea syndrome (OSAHS) patients with different severities and its significances. Methods A total of 134 elderly OSAHS patients admitted to our hospital from February 2012 to October 2016 were retrospectively recruited in this study. According to their apnea hypopnea index (AHI), they were divided into severe group (n=55), moderate group (n=41) and mild group (n=38). Polysomno-graphy (PSG) indicators, MPO and amylin levels were compared among the 3 groups. Spearman correlation analysis was used to analyze the influencing factors of amylin and MPO levels. SPSS statistics 13.0 was employed to analyze the data. Analysis of variance or Chi-square test was applied to make intergroup comparison according to different data types. Results Compared with the severe group, AHI, oxygen desaturation index (ODI), apnea and hypopnea frequency were decreased significantly, and the lowest oxygen saturation (LSaO₂) and mean arterial oxygen saturation (MSaO₂) at night were increased obviously in the mild group and the moderate group (P<0.05). Before continuous positive airway pressure (CPAP) ventilation treatment, the severe group had notably higher serum levels of amylin [(47.85±6.41) vs (20.29±3.06) and (31.57±5.27)ng/ml] and MPO [(37.92±9.88) vs (7.61±2.04) and (23.33±4.56)ng/mg] than the mild and moderate groups (P<0.05). In 6 months and 1 year after the treatment, the serum levels of amylin [(34.17±4.96) and (27.14±3.86) vs (47.85±6.41)ng/ml] and MPO [(21.06±8.39) and (12.17±7.53) vs(37.92±9.88)ng/mg] were significantly lower in the patients of the severe group when compared with the levels before treatment (P<0.05). Spearman correlation analysis showed that MPO and amylin levels were negatively correlated with LSaO₂ and MSaO₂, and positively correlated with AHI and apnea frequency. Conclusion Serum amylin and MPO levels show reference values in evaluation of the risk for insulin resistance and of the therapeutic effect of CPAP in elderly OSAHS patients.