吕纪玲　张永发　魏艳丽　张胜亮　侯玉涛

[摘要] 目的 探討持续气道正压通气（CPAP）对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者肱踝动脉脉搏波传导速度（baPWV ）水平的影响。 方法 选取因“打鼾或其他睡眠呼吸障碍症状”就诊的118例患者，同时选取30例无睡眠打鼾者作为正常对照组，行多导睡眠监测（PSG），据PSG检测结果将患者分为四组：（1）正常对照组；（2）单纯打鼾组；（3）轻度OSAHS组；（4）中重度OSAHS组，分别行ESS问卷调查、测定血清pentraxin-3、baPWV，并将中重度OSAHS患者随机分为CPAP治疗组和观察组，治疗6个月后对两组再次行ESS问卷调查、PSG监测、baPWV及pentraxin-3测定。 结果 中重度OSAHS组血清pentraxin-3浓度、baPWV明显高于轻度OSAHS组、单纯打鼾组和正常对照组（P均<0.05）。中重度OSAHS治疗组经CPAP治疗后pentraxin-3、ESS、AHI及baPWV均明显下降，最低血氧饱和度（LSaO2）明显升高，与治疗前比较，差异有统计学意义（P均<0.05），而且治疗组pentraxin-3的改变与baPWV的改变呈正相关（r=0.53；P<0.01），与CPAP的应用时间呈负相关（r=-0.60；P<0.01）。 结论 pentraxin-3在中重度OSAHS患者中明显高于轻度OSAHS者、单纯打鼾者、正常患者，CPAP治疗能降低中重度OSAHS患者pentraxin-3及baPWV的水平。

[关键词] 阻塞性睡眠呼吸暂停低通气综合征；正五聚蛋白-3；持续气道正压通气；肱踝动脉脉搏波传导速度

[中图分类号] R563.1 [文献标识码] A [文章编号] 1673-9701（2017）12-0005-04

[Abstract] Objective To investigate the effect of continuous positive airway pressure （CPAP） on arterial pulse wave velocity （baPWV） in patients with obstructive sleep apnea hypopnea syndrome（OSAHS）. Methods A total of 118 patients who were admitted in hospital due to "snoring or other symptoms of sleep-disordered breathing" were selected and 30 patients without sleep snoring were selected as normal control group in the same period. The patients underwent polysomnography（PSG）. And they were divided into four groups including， （1）normal control group， （2）simple snoring group，（3）mild OSAHS group， （4）moderate to severe OSAHS group according to PSG test results， and were given ESS questionnaire survey， determination of serum pentraxin-3， baPWV， respectively.And moderate to severe OSAHS patients were randomly divided into CPAP treatment group and observation group. The ESS questionnaires， PSG monitoring， baPWV and pentraxin-3 detecting were performed between the two groups after 6 months of treatment. Results The levels of serum pentraxin-3 concentration and baPWV were significantly higher in moderate to severe OSAHS group than those in mild OSAHS group， simple snoring group and normal control group（P<0.05）. The levels of pentraxin-3， ESS， AHI and baPWV were significantly decreased and the lowest oxygen saturation（LSaO2） was significantly higher in the moderate to severe OSAHS group after CPAP treatment，and the difference was statistically significant， compared than those before treatment（P<0.05）. The change of pentraxin-3 in the treatment group was positively correlated with the change of baPWV（r=0.53， P<0.01） and was negatively corrected with the application time of CPAP（r=-0.60， P<0.01）. Conclusion Pentraxin-3 is significantly higher in the moderate to severe OSAHS patients than that of the mild OSAHS，simple snoring and normal patients.CPAP treatment can reduce the levels of pentraxin-3 and baPWV in moderate to severe OSAHS patients.

[Key words] Obstructive sleep apnea hypopnea syndrome； Positive pentagystin-3； Persistent positive airway pressure； Brachial ankle artery pulse wave velocity

阻塞性睡眠呼吸暂停低通气综合征（OSAHS）是最为常见的一种睡眠呼吸疾病，临床上以睡眠时反复发作上气道塌陷阻塞为特征[1]，其引起慢性间断性低氧血症和睡眠结构紊乱[2-4]，OSAHS与动脉粥样硬化独立相关[5-6]，引起多器官功能损害[7-9]，影响患者的生活质量和寿命。正五聚蛋白-3（pentraxin-3） 是近年发现的新炎性标志物，与血管炎症标志物CRP同属于五聚体蛋白超家族成员[10-11]，它是由血管内皮细胞、炎性细胞、成纤维细胞、脂肪细胞、平滑肌细胞分泌并释放入血[12]，与CRP相比，它可能更好地反映了心血管系统的局部炎症，且血浓度比CRP变异性更小[13-15]。我们在前期的研究[16]发现pentraxin-3在OSAHS患者中升高，且与肱踝动脉脉搏波传导速度（baPWV）呈正相关。……