血清TNF-α和HIF-1α水平与高血压合并中重度OSAHS的关系及nCPAP治疗对其的影响
|
摘要
目的:观察经鼻持续正压通气(nCPAP)对高血压合并中重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血清肿瘤坏死因子α(TNF-α)、缺氧诱导因子-1α(HIF-1α)水平的影响。方法:42例高血压合并中重度OSAHS患者为研究组,40例单纯高血压患者为高血压组,同期20例体检正常者为对照组;于入院或者体检时采用酶联免疫吸附实验法(ELISA)检测3组受试者血清TNF-α及HIF-1α的水平;研究组患者再均分为常规治疗组(常规药物治疗)及联合治疗组(常规药物治疗联合nCPAP治疗),分别检测治疗前、治疗1个月及6个月时血清TNF-α及HIF-1α水平,并记录AHI值及血压。结果:3组被检者血清TNF-α及HIF-1水平研究组>高血压组>对照组,差异有统计学意义(P <0. 05);治疗后,联合治疗组AHI值、血压及血清TNF-α、HIF-1α水平均较常规治疗组降低,差异有统计学意义(P <0. 05);治疗后,联合治疗组患者AHI值、血压及血清TNF-α、HIF-1α水平均较治疗前显著降低(P <0. 05),且治疗6个月时的数值显著低于治疗1个月(P <0. 05);常规治疗组患者仅治疗6个月时血压、血清TNF-α均较治疗前显著降低,差异有统计学意义(P <0. 05);其余指标比较差异无统计学意义(P> 0. 05)。结论:常规治疗联合nCPAP对高血压合并OSAHS患者的治疗效果可能与降低患者血液TNF-α及HIF-1α水平有关。
Objective: To investigate the curative effects and prognosis of nasal continuous positive airway pressure( nCPAP) treatment by observing the levels of hypoxia-inducible factor-1α( HIF-1α)and TNF-α in hypertension patients with moderate to severe obstructive sleep apnea hypopnea syndrome( OSAHS). Method: 42 hypertension patients with moderate to severe OSAHS were chosen as study group. 40 hypertension patients without OSAHS as hypertension group. In addition,20 people received physical examination were chosen as blank group. The expression of TNF-αand HIF-1αlevels of all groups were detected by ELISA when admitted to hospital or during physical check. Patients in the study group were equally and randomly divided into conventional study group( conventional drug therapy) and combined study group( conventional drug therapy combined with nCPAP therapy). Serum TNF-α and HIF-1α level were detected before treatment,1 month and 6 months after treatment;blood pressure and AHI value were recorded. Results: HIF-1α and TNF-α level in decreasing order as,study group,simple hypertension and blank group,differences were statistically significant( P <0. 05); after treatment,AHI value,blood pressure and serum HIF-1α and TNF-α level of combined treatment group was lowered than conventional treatment group,differences were statistically significant( P < 0. 05); after treatment,AHI value,blood pressure and serum HIF-1α and TNF-α level of combined treatment group was significantly lowered than before treatment( P < 0. 05),and the value of 6 months after treatment was significantly lower than that of one month( P < 0. 05); blood pressure and serum TNF-α of conventional treatment group 6 months after treatment were obviously lowered than before treatment,differences were statistically significant( P < 0. 05); other parameters were not statistically significant( P < 0. 05). Conclusions: The efficacy of conventional treatment combined nCPAP on hypertension patient with OSAHS might be related with the patients' serum HIF-1α and HIF-1α.
Objective: To investigate the curative effects and prognosis of nasal continuous positive airway pressure( nCPAP) treatment by observing the levels of hypoxia-inducible factor-1α( HIF-1α)and TNF-α in hypertension patients with moderate to severe obstructive sleep apnea hypopnea syndrome( OSAHS). Method: 42 hypertension patients with moderate to severe OSAHS were chosen as study group. 40 hypertension patients without OSAHS as hypertension group. In addition,20 people received physical examination were chosen as blank group. The expression of TNF-αand HIF-1αlevels of all groups were detected by ELISA when admitted to hospital or during physical check. Patients in the study group were equally and randomly divided into conventional study group( conventional drug therapy) and combined study group( conventional drug therapy combined with nCPAP therapy). Serum TNF-α and HIF-1α level were detected before treatment,1 month and 6 months after treatment;blood pressure and AHI value were recorded. Results: HIF-1α and TNF-α level in decreasing order as,study group,simple hypertension and blank group,differences were statistically significant( P <0. 05); after treatment,AHI value,blood pressure and serum HIF-1α and TNF-α level of combined treatment group was lowered than conventional treatment group,differences were statistically significant( P < 0. 05); after treatment,AHI value,blood pressure and serum HIF-1α and TNF-α level of combined treatment group was significantly lowered than before treatment( P < 0. 05),and the value of 6 months after treatment was significantly lower than that of one month( P < 0. 05); blood pressure and serum TNF-α of conventional treatment group 6 months after treatment were obviously lowered than before treatment,differences were statistically significant( P < 0. 05); other parameters were not statistically significant( P < 0. 05). Conclusions: The efficacy of conventional treatment combined nCPAP on hypertension patient with OSAHS might be related with the patients' serum HIF-1α and HIF-1α.
引文
[1]LIEBERMAN J A. Obstructive sleep apnea(OSA)and excessive sleepiness associated with OSA:recognition in the primary care setting[J]. Postgrad Med,2009,121(4):33-41.
[2]BIELICKI P,MACLEOD A K,DOUGLAS N J,et al. Cytokine gene polymorphisms in obstructive sleep apnoea/hypopnoea syndrome[J]. Sleep Med,2015,16(6):792-795.
[3] HUI P,JIA S,MA W,et al. The clinical significance and changes of serum tumor necrosis factor and plasma endothelium in patients with OSAHS associated Type 2 diabetes mellites[J]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi,2016,30(3):217-225.
[4] YOKOE T,MINOGUCHI M K,MATSUO H. Elevated levels of C-reactive protein and interlteuk in-6 in patients with obstictive sleep apnea syndrom eare decreased nasal continuous positie airway pressure[J]. Circulation,2003,107(8):1129-1134.
[5]GARCIA-RIO F I,PINO J M,ALONSO A,et al. White coat hypertension in patients with obstructive sleep apneahypopnea syndrome[J]. Chest, 2004,125(3):817-822.
[6]PEPPARD P E,YOUNG T,PALTA M,et a. l Prospective study of theassociation between sleep disordered breathing and hyp ertension[J]. N Eng JM ed,2000,324(19):1378-1384.
[7] AMERICAN ACADEMY OF SLEEP MEDICINE TASK FORCE. Sleeprelated breathing disorders in adults:recommend dations for syndrome definition and measurement techniques in clinical research[J]. Sleep,1999,22(5):667-689.
[8]KING S,CUELLAR N. Obstructive sleep apnea as an independent stroke risk factor:A review of the evidence,stroke prevention guidelines,and implications for neuroscience nursing practice[J]. J Neurosci Nurs,2016,48(3):133-142.
[9] PARATI G,OCHOA J E,BILO G,et al. Obstructive sleep apnea syndrome as a cause of resistant hypertension[J]. Hypertens Res,2014,37(7):601-613.
[10]ZHANG P,GUO W J. The research progress of OSAHS and cardiovascular disease[J]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi,2016,30(6):442-445.
[11]JIN Z N,WEI Y X. Meta-analysis of effects of obstructive sleep apnea on the renin-angiotensin-aldosterone system[J]. J Geriatr Cardiol,2016,13(4):333-343.
[12]JENNUM P,RIHA R L. Epidemiology of sleep apnoea/hypopnoea syndrome and sleep-disordered breathing[J].Eur Respir J,2009,33(4):907-914.
[13]VECCHIERINI M F. Obstructif sleep apnea-hypopnea syndrome:evolution of an old concept[J]. Neurochirurgie,2006,52(5):432-442.
[14]BARBEF,DURAN-CANTOLLA J,SANCHEZ-DE-LATORRE M,et al. Effect of continuous positive airway pressure on the incidence of hypertension and cardiovascular events in nonsleepy patients with obstructive sleep apnea:a randomized controlled trial[J]. JAMA,2012,307(20):2161-2168.
[15]GUEST J F,HELTER M T,MORGA A,et al. Cost-effectiveness of using continuous positive airway pressure in the treatment of severe obstructive sleep apnoea/hypopnoea syndrome in the UK[J]. Thorax,2008,63(10):860-865.
[16]MARCELLA R,ATUL R,KENNETH N. Obstructive sleep apnea and its effects on cardiovascular diseases:a narrative review[J]. Anatol J Cardiol,2016,15(11):944-950.
[17]MO X,LIU J,XIE Y,et al. Analysis of clinical characteristics and risk factors of obstructive sleep apnea hypopnea syndrome with hypertension[J]. Zhong hua Yi Xue Za Zhi,2016,96(8):605-609.
[18]MINOGUCHI K,TAZAKI T,YOKOE T,et al. Elevated production of tumor necrosis factor-alpha by monocytes in patients with obstructive sleep apnea syndrome[J].Chest,2004,126(5):1473-1479.
[19]WANG X,QIU J,WANG Y,et al. Beneficial response of blood pressure to short-term continuous positive airway pressure in Chinese patients with obstructive sleep apneahypopnea syndrome[J]. Blood Press Monit,2018,23(4):175-184.
[20]CAMPOS-RODRIGUEZ F,GONZALEZ-MARTINEZ M,SANCHEZ-ARMENGOL A,et al. Effect of continuous positive airway pressure on blood pressure and metabolic profile in women with sleep apnoea[J]. Eur Respir J,2017,50(2):257-264.
[21]SAPINA-BELTRAN E,TORRES G,MARTINEZ-ALONSO M,et al. Rationale and methodology of the SARAH trial:long-term cardiovascular outcomes in patients with resistant hypertension and obstructive sleep apnea[J].Arch Bronconeumol,2018,22(10):1016-1019.
[2]BIELICKI P,MACLEOD A K,DOUGLAS N J,et al. Cytokine gene polymorphisms in obstructive sleep apnoea/hypopnoea syndrome[J]. Sleep Med,2015,16(6):792-795.
[3] HUI P,JIA S,MA W,et al. The clinical significance and changes of serum tumor necrosis factor and plasma endothelium in patients with OSAHS associated Type 2 diabetes mellites[J]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi,2016,30(3):217-225.
[4] YOKOE T,MINOGUCHI M K,MATSUO H. Elevated levels of C-reactive protein and interlteuk in-6 in patients with obstictive sleep apnea syndrom eare decreased nasal continuous positie airway pressure[J]. Circulation,2003,107(8):1129-1134.
[5]GARCIA-RIO F I,PINO J M,ALONSO A,et al. White coat hypertension in patients with obstructive sleep apneahypopnea syndrome[J]. Chest, 2004,125(3):817-822.
[6]PEPPARD P E,YOUNG T,PALTA M,et a. l Prospective study of theassociation between sleep disordered breathing and hyp ertension[J]. N Eng JM ed,2000,324(19):1378-1384.
[7] AMERICAN ACADEMY OF SLEEP MEDICINE TASK FORCE. Sleeprelated breathing disorders in adults:recommend dations for syndrome definition and measurement techniques in clinical research[J]. Sleep,1999,22(5):667-689.
[8]KING S,CUELLAR N. Obstructive sleep apnea as an independent stroke risk factor:A review of the evidence,stroke prevention guidelines,and implications for neuroscience nursing practice[J]. J Neurosci Nurs,2016,48(3):133-142.
[9] PARATI G,OCHOA J E,BILO G,et al. Obstructive sleep apnea syndrome as a cause of resistant hypertension[J]. Hypertens Res,2014,37(7):601-613.
[10]ZHANG P,GUO W J. The research progress of OSAHS and cardiovascular disease[J]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi,2016,30(6):442-445.
[11]JIN Z N,WEI Y X. Meta-analysis of effects of obstructive sleep apnea on the renin-angiotensin-aldosterone system[J]. J Geriatr Cardiol,2016,13(4):333-343.
[12]JENNUM P,RIHA R L. Epidemiology of sleep apnoea/hypopnoea syndrome and sleep-disordered breathing[J].Eur Respir J,2009,33(4):907-914.
[13]VECCHIERINI M F. Obstructif sleep apnea-hypopnea syndrome:evolution of an old concept[J]. Neurochirurgie,2006,52(5):432-442.
[14]BARBEF,DURAN-CANTOLLA J,SANCHEZ-DE-LATORRE M,et al. Effect of continuous positive airway pressure on the incidence of hypertension and cardiovascular events in nonsleepy patients with obstructive sleep apnea:a randomized controlled trial[J]. JAMA,2012,307(20):2161-2168.
[15]GUEST J F,HELTER M T,MORGA A,et al. Cost-effectiveness of using continuous positive airway pressure in the treatment of severe obstructive sleep apnoea/hypopnoea syndrome in the UK[J]. Thorax,2008,63(10):860-865.
[16]MARCELLA R,ATUL R,KENNETH N. Obstructive sleep apnea and its effects on cardiovascular diseases:a narrative review[J]. Anatol J Cardiol,2016,15(11):944-950.
[17]MO X,LIU J,XIE Y,et al. Analysis of clinical characteristics and risk factors of obstructive sleep apnea hypopnea syndrome with hypertension[J]. Zhong hua Yi Xue Za Zhi,2016,96(8):605-609.
[18]MINOGUCHI K,TAZAKI T,YOKOE T,et al. Elevated production of tumor necrosis factor-alpha by monocytes in patients with obstructive sleep apnea syndrome[J].Chest,2004,126(5):1473-1479.
[19]WANG X,QIU J,WANG Y,et al. Beneficial response of blood pressure to short-term continuous positive airway pressure in Chinese patients with obstructive sleep apneahypopnea syndrome[J]. Blood Press Monit,2018,23(4):175-184.
[20]CAMPOS-RODRIGUEZ F,GONZALEZ-MARTINEZ M,SANCHEZ-ARMENGOL A,et al. Effect of continuous positive airway pressure on blood pressure and metabolic profile in women with sleep apnoea[J]. Eur Respir J,2017,50(2):257-264.
[21]SAPINA-BELTRAN E,TORRES G,MARTINEZ-ALONSO M,et al. Rationale and methodology of the SARAH trial:long-term cardiovascular outcomes in patients with resistant hypertension and obstructive sleep apnea[J].Arch Bronconeumol,2018,22(10):1016-1019.