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目的探讨经鼻持续气道正压(nCPAP)通气对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并冠心病内皮功能的影响。方法选OSAHS(OSAHS组)、冠心病(冠心病组)、OSAHS合并冠心病(OSAHS合并冠心病组)及对照(对照组)者各20例,行多导睡眠图监测,计算平均脉搏血氧饱和度(MSpO2)、SpO2≤90%的累积时间占总睡眠时间百分比(CT90);对OSAHS、OSAHS合并冠心病者行nCPAP通气治疗,观察MSpO2、CT90的变化。测4组受试者血清NO、血浆内皮素-1(ET-1)水平。结果(1)logistic回归分析显示,OSAHS是冠心病发生的重要原因之一。(2)与对照组和冠心病组相比,OSAHS组、OSAHS合并冠心病组CT90、ET-1升高,MSpO2、NO下降,差异有统计学意义(P<0.01)。OSAHS合并冠心病组与OSAHS组相比,CT90、MSpO2差异无统计学意义(P>0.05);但ET-1高于后者,NO低于后者,差异有统计学意义(P<0.01)。(3)OSAHS组NO水平与MSpO2呈正相关,与CT90呈负相关;ET-1水平与MSpO2呈负相关,与CT90呈正相关。(4)nCPAP通气治疗后,OSAHS组、OSAHS合并冠心病组MSpO2、NO较治疗前均升高,CT90、ET-1均降低(P<0.01)。结论OSAHS是冠心病的重要危险因素之一。OSAHS可引起内皮功能不全,OSAHS合并冠心病时内皮功能损害更显著,血管内皮功能的损害可能是OSAHS形成或加重冠心病的机制之一。nCPAP通气治疗可改善OSAHS患者血管内皮功能,与夜间低氧血症的改善相关。
Objective To investigate the effect of nasal continuous positive airway pressure (nCPAP) ventilation on endothelial function in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and coronary heart disease (CHD). Methods OSAHS (group OSAHS), coronary heart disease (group CHD), OSAHS combined with coronary heart disease (group OSAHS with coronary heart disease) and control group (n = 20) were enrolled in this study. Polysomnography was performed to calculate mean pulse oximetry (MSpO2), SpO2≤90% of total sleep time (CT90); OSAHS, OSAHS patients with coronary heart disease nCPAP ventilation treatment, observed MSpO2, CT90 changes. The serum NO and plasma endothelin-1 (ET-1) levels were measured in 4 subjects. Results (1) Logistic regression analysis showed that OSAHS was one of the important causes of coronary heart disease. (2) Compared with the control group and the CHD group, the levels of CT90, ET-1 and MSpO2, NO in OSAHS group and OSAHS group were significantly decreased (P <0.01). Compared with OSAHS group, there was no significant difference in CT90 and MSpO2 between OSAHS group and OSAHS group (P> 0.05), but ET-1 was higher than the latter and NO was lower than the latter (P <0.01) . (3) NO levels in OSAHS group were positively correlated with MSpO2 and negatively correlated with CT90. ET-1 level was negatively correlated with MSpO2 and positively correlated with CT90. (4) After nCPAP ventilation, the levels of MSpO2 and NO in OSAHS group and OSAHS group were both higher than those before treatment, while the levels of CT90 and ET-1 in OSAHS group and OSAHS group were both decreased (P <0.01). Conclusion OSAHS is one of the important risk factors of coronary heart disease. OSAHS can cause endothelial dysfunction, OSAHS endothelial dysfunction in patients with coronary heart disease more significant, the damage of vascular endothelial function may be OSAHS formation or increase one of the mechanisms of coronary heart disease. nCPAP ventilation improves vascular endothelial function in OSAHS patients and correlates with improvement of nocturnal hypoxemia.