OSAHS手术前后呼出气冷凝液中瘦素检测的临床意义
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摘要
目的探讨呼出气冷凝液(EBC)中瘦素检测对评估OSAHS的严重程度及手术疗效的意义。方法根据多导睡眠监测(PSG)检查结果,实验共纳入中重度OSAHS组33例、轻度OSAHS组20例、对照组20例(慢性扁桃体炎患者经PSG检查排除OSAHS)。OSAHS患者接受保留悬雍垂的改良悬雍垂腭咽成形术(R-UPPP)。采用ELISA检测EBC中瘦素水平,并分析中重度OSAHS组EBC中瘦素水平手术前后变化,瘦素与BMI、呼吸睡眠紊乱指数(AHI)、最低血氧饱和度(LSa O2)的相关性。结果中重度OSAHS组晨起EBC中瘦素水平高于轻度OSAHS组(LSD-t=5.039,P<0.05)与对照组(LSD-t=5.859,P<0.05);轻度OSAHS组与对照组比较,差异无统计学意义(LSD-t=0.830,P>0.05)。中重度OSAHS组手术后EBC中瘦素水平降低,与手术前比较,差异有统计学意义(t=11.088,P<0.05)。中重度OSAHS组EBC中瘦素水平分别与BMI(r=0.773,P<0.01)、AHI(r=0.796,P<0.01)呈正相关,与LSa O2呈负相关(r=-0.875,P<0.01)。结论 EBC中瘦素水平在中重度OSAHS患者中显著升高,与OSAHS的严重程度有相关性,可作为评价OSAHS患者严重程度及手术疗效的评价方法。
Objective To investigate the clinical significance of leptin in the exhaled breath condensate( EBC) in evaluating the severity of patients with obstructive sleep apnea-hypopnea syndrome( OSAHS)and clinical efficacy of modified uvulopalatopharyngoplasty with uvula preservation( R-UPPP). Methods According to the results of polysomnography( PSG) test,33 patients were diagnosed with moderate and severe OSAHS,20 patients with mild OSAHS,and 20 patients with chronic tonsillitis were recruited into the control group. Patients with OSAHS underwent R-UPPP. The level of leptin in EBC was quantitatively measured by ELISA. In the moderate and severe OSAHS group,the changes of leptin levels in EBC were investigated before and after surgery. The correlation between leptin,BMI,apnoea-hypopnoea index( AHI) and LSa O2 was statistically analyzed. Results In the morning,the level of leptin in EBC in the moderate and severe OSAHS group was significantly higher than those in the mild OSAHS( LSD-t = 5. 039,P < 0. 05) and control groups( LSD-t= 5. 859,P < 0. 05). No statistical significance was observed between the mild OSAHS and control groups(LSD-t = 0. 830,P > 0. 05). In the moderate and severe OSAHS group,the level of leptin in EBC was significantly down-regulated after surgery( t = 11. 088,P < 0. 05). In the moderate and severe OSAHS group,the level of leptin in EBC was significantly positively correlated with BMI( r = 0. 773,P < 0. 01) and AHI( r =0. 796,P < 0. 01),whereas negatively associated with LSa O2( r =-0. 875,P < 0. 01). Conclusions The level of leptin in EBC is significantly elevated in patients with moderate and severe OSAHS. It is correlated with the severity of OSAHS,which can be utilized as an evaluation biomarker to evaluate the severity and surgical efficacy in OSAHS patients.
Objective To investigate the clinical significance of leptin in the exhaled breath condensate( EBC) in evaluating the severity of patients with obstructive sleep apnea-hypopnea syndrome( OSAHS)and clinical efficacy of modified uvulopalatopharyngoplasty with uvula preservation( R-UPPP). Methods According to the results of polysomnography( PSG) test,33 patients were diagnosed with moderate and severe OSAHS,20 patients with mild OSAHS,and 20 patients with chronic tonsillitis were recruited into the control group. Patients with OSAHS underwent R-UPPP. The level of leptin in EBC was quantitatively measured by ELISA. In the moderate and severe OSAHS group,the changes of leptin levels in EBC were investigated before and after surgery. The correlation between leptin,BMI,apnoea-hypopnoea index( AHI) and LSa O2 was statistically analyzed. Results In the morning,the level of leptin in EBC in the moderate and severe OSAHS group was significantly higher than those in the mild OSAHS( LSD-t = 5. 039,P < 0. 05) and control groups( LSD-t= 5. 859,P < 0. 05). No statistical significance was observed between the mild OSAHS and control groups(LSD-t = 0. 830,P > 0. 05). In the moderate and severe OSAHS group,the level of leptin in EBC was significantly down-regulated after surgery( t = 11. 088,P < 0. 05). In the moderate and severe OSAHS group,the level of leptin in EBC was significantly positively correlated with BMI( r = 0. 773,P < 0. 01) and AHI( r =0. 796,P < 0. 01),whereas negatively associated with LSa O2( r =-0. 875,P < 0. 01). Conclusions The level of leptin in EBC is significantly elevated in patients with moderate and severe OSAHS. It is correlated with the severity of OSAHS,which can be utilized as an evaluation biomarker to evaluate the severity and surgical efficacy in OSAHS patients.
引文
[1]叶京英,李彦如,王小轶,寇屹,张玉焕,丁秀,尹国平,李宏彬.阻塞性睡眠呼吸暂停低通气综合征临床分级标准的研究.中华医学杂志,2005,85(32):2274-2278.
[2]张景波,杜兴娟.重度阻塞性睡眠呼吸暂停低通气综合征致深昏迷一例.新医学,2013,44(4):288-289.
[3]中华耳鼻咽喉科头颈外科杂志编辑委员会,中华医学会耳鼻咽喉科头颈外科分会咽喉学组.阻塞性睡眠呼吸暂停低通气综合征诊断和外科治疗指南.中华耳鼻咽喉头颈外科杂志,2009,44(2):95-96.
[4]Berry RB,Budhiraja R,Gottlieb DJ,Gozal D,Iber C,Kapur VK,Marcus CL,Mehra R,Parthasarathy S,Quan SF,Redline S,Strohl KP,Davidson Ward SL,Tangredi MM;American Academy of Sleep Medicine.Rules for scoring respiratory events in sleep:update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events.Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine.J Clin Sleep Med,2012,8(5):597-619.
[5]Antonopoulou S,Loukides S,Papatheodorou G,Roussos C,Alchanatis M.Airway inflammation in obstructive sleep apnea:is leptin the missing link?Respir Med,2008,102(10):1399-1405.
[6]Friedman M,Ibrahim H,Bass L.Clinical staging for sleep disordered breathing.Otolaryngol Head Neck Surg,2002,127(1):13-21.
[7]Horváth I,Hunt J,Barnes PJ,Alving K,Antczak A,Baraldi E,Becher G,van Beurden WJ,Corradi M,Dekhuijzen R,Dweik RA,Dwyer T,Effros R,Erzurum S,Gaston B,Gessner C,Greening A,Ho LP,Hohlfeld J,J9bsis Q,Laskowski D,Loukides S,Marlin D,Montuschi P,Olin AC,Redington AE,Reinhold P,van Rensen EL,Rubinstein I,Silkoff P,Toren K,Vass G,Vogelberg C,Wirtz H;ATS/ERS Task Force on Exhaled Breath Condensate.Exhaled breath condensate:methodological recommendations and unresolved questions.Eur Respir J,2005,26(3):523-548.
[8]韩德民.关注上呼吸道阻塞性疾病的源头性作用.中华耳鼻咽喉头颈外科杂志,2008,43(3):161-162.
[9]张湘民.阻塞性睡眠呼吸暂停低通气综合征定位诊断之惑.山东大学耳鼻喉眼学报,2017,31(1):4-7,17.
[10]Imayama I,Prasad B.Role of leptin in obstructive sleep apnea.Ann Am Thorac Soc,2017,14(11):1607-1621.
[11]Peng Y,Zhou L,Cao Y,Chen P,Chen Y,Zong D,Ouyang R.Relation between serum leptin levels,lipid profiles and neurocognitive deficits in Chinese OSAHS patients.Int J Neurosci,2017,127(11):981-987.
[12]巫翠华,钟春,林映花,朱一鑫.阻塞性睡眠呼吸暂停低通气综合征患者呼出气冷凝液中瘦素的研究.医学前沿,2017,7(33):226-227.
[13]叶京英.浅谈OSAHS临床热点问题——写在本期组稿之前.临床耳鼻咽喉头颈外科杂志,2016,30(6):427-428,433.
[14]Yao Q,Pho H,Kirkness J,Ladenheim EE,Bi S,Moran TH,Fuller DD,Schwartz AR,Polotsky VY.Localizing effects of leptin on upper airway and respiratory control during sleep.Sleep,2016,39(5):1097-1106.
[15]Banks WA,Farrell CL.Impaired transport of leptin across the blood-brain barrier in obesity is acquired and reversible.Am J Physiol Endocrinol Metab,2003,285(1):E10-E15.
[16]Caro JF,Kolaczynski JW,Nyce MR,Ohannesian JP,Opentanova I,Goldman WH,Lynn RB,Zhang PL,Sinha MK,Considine RV.Decreased cerebrospinal-fluid/serum leptin ratio in obesity:a possible mechanism for leptin resistance.Lancet,1996,348(9021):159-161.
[17]Enriori PJ,Evans AE,Sinnayah P,Jobst EE,Tonelli-Lemos L,Billes SK,Glavas MM,Grayson BE,Perello M,Nillni EA,Grove KL,Cowley MA.Diet-induced obesity causes severe but reversible leptin resistance in arcuate melanocortin neurons.Cell Metab,2007,5(3):181-194.
[18]Scarpace PJ,Zhang Y.Leptin resistance:a prediposing factor for diet-induced obesity.Am J Physiol Regul Integr Comp Physiol,2009,296(3):R493-R500.
[19]Lin CC,Wang YP,Lee KS,Liaw SF,Chiu CH.Effect of uvulopalatopharyngoplasty on leptin and endothelial function in sleep apnea.Ann Otol Rhinol Laryngol,2014,123(1):40-46.
[20]叶京英,李京京.阻塞性睡眠呼吸暂停低通气综合征的干预指征及治疗方法.中国临床医生,2013,41(7):468-471.
[21]Carpagnano GE,Spanevello A,Curci C,Salerno F,Palladino GP,Resta O,Di Gioia G,Carpagnano F,Foschino Barbaro MP.IL-2,TNF-alpha,and leptin:local versus systemic concentrations in NSCLC patients.Oncol Res,2007,16(8):375-381.
[22]曹淑芳,谭瑞星,黄冬薇.OSAHS患者呼出气冷凝液和血清中去甲肾上腺素、瘦素水平检测的临床意义.中国实验诊断学,2014,18(7):1098-1101.
[23]王胜国,周本忠,孙敬武,胡勇,李皓,兰兰.阻塞性睡眠呼吸暂停低通气综合征患者咽部组织中瘦素受体表达的研究.中华耳鼻喉头颈外科杂志,2005,40(10):787-788.
[2]张景波,杜兴娟.重度阻塞性睡眠呼吸暂停低通气综合征致深昏迷一例.新医学,2013,44(4):288-289.
[3]中华耳鼻咽喉科头颈外科杂志编辑委员会,中华医学会耳鼻咽喉科头颈外科分会咽喉学组.阻塞性睡眠呼吸暂停低通气综合征诊断和外科治疗指南.中华耳鼻咽喉头颈外科杂志,2009,44(2):95-96.
[4]Berry RB,Budhiraja R,Gottlieb DJ,Gozal D,Iber C,Kapur VK,Marcus CL,Mehra R,Parthasarathy S,Quan SF,Redline S,Strohl KP,Davidson Ward SL,Tangredi MM;American Academy of Sleep Medicine.Rules for scoring respiratory events in sleep:update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events.Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine.J Clin Sleep Med,2012,8(5):597-619.
[5]Antonopoulou S,Loukides S,Papatheodorou G,Roussos C,Alchanatis M.Airway inflammation in obstructive sleep apnea:is leptin the missing link?Respir Med,2008,102(10):1399-1405.
[6]Friedman M,Ibrahim H,Bass L.Clinical staging for sleep disordered breathing.Otolaryngol Head Neck Surg,2002,127(1):13-21.
[7]Horváth I,Hunt J,Barnes PJ,Alving K,Antczak A,Baraldi E,Becher G,van Beurden WJ,Corradi M,Dekhuijzen R,Dweik RA,Dwyer T,Effros R,Erzurum S,Gaston B,Gessner C,Greening A,Ho LP,Hohlfeld J,J9bsis Q,Laskowski D,Loukides S,Marlin D,Montuschi P,Olin AC,Redington AE,Reinhold P,van Rensen EL,Rubinstein I,Silkoff P,Toren K,Vass G,Vogelberg C,Wirtz H;ATS/ERS Task Force on Exhaled Breath Condensate.Exhaled breath condensate:methodological recommendations and unresolved questions.Eur Respir J,2005,26(3):523-548.
[8]韩德民.关注上呼吸道阻塞性疾病的源头性作用.中华耳鼻咽喉头颈外科杂志,2008,43(3):161-162.
[9]张湘民.阻塞性睡眠呼吸暂停低通气综合征定位诊断之惑.山东大学耳鼻喉眼学报,2017,31(1):4-7,17.
[10]Imayama I,Prasad B.Role of leptin in obstructive sleep apnea.Ann Am Thorac Soc,2017,14(11):1607-1621.
[11]Peng Y,Zhou L,Cao Y,Chen P,Chen Y,Zong D,Ouyang R.Relation between serum leptin levels,lipid profiles and neurocognitive deficits in Chinese OSAHS patients.Int J Neurosci,2017,127(11):981-987.
[12]巫翠华,钟春,林映花,朱一鑫.阻塞性睡眠呼吸暂停低通气综合征患者呼出气冷凝液中瘦素的研究.医学前沿,2017,7(33):226-227.
[13]叶京英.浅谈OSAHS临床热点问题——写在本期组稿之前.临床耳鼻咽喉头颈外科杂志,2016,30(6):427-428,433.
[14]Yao Q,Pho H,Kirkness J,Ladenheim EE,Bi S,Moran TH,Fuller DD,Schwartz AR,Polotsky VY.Localizing effects of leptin on upper airway and respiratory control during sleep.Sleep,2016,39(5):1097-1106.
[15]Banks WA,Farrell CL.Impaired transport of leptin across the blood-brain barrier in obesity is acquired and reversible.Am J Physiol Endocrinol Metab,2003,285(1):E10-E15.
[16]Caro JF,Kolaczynski JW,Nyce MR,Ohannesian JP,Opentanova I,Goldman WH,Lynn RB,Zhang PL,Sinha MK,Considine RV.Decreased cerebrospinal-fluid/serum leptin ratio in obesity:a possible mechanism for leptin resistance.Lancet,1996,348(9021):159-161.
[17]Enriori PJ,Evans AE,Sinnayah P,Jobst EE,Tonelli-Lemos L,Billes SK,Glavas MM,Grayson BE,Perello M,Nillni EA,Grove KL,Cowley MA.Diet-induced obesity causes severe but reversible leptin resistance in arcuate melanocortin neurons.Cell Metab,2007,5(3):181-194.
[18]Scarpace PJ,Zhang Y.Leptin resistance:a prediposing factor for diet-induced obesity.Am J Physiol Regul Integr Comp Physiol,2009,296(3):R493-R500.
[19]Lin CC,Wang YP,Lee KS,Liaw SF,Chiu CH.Effect of uvulopalatopharyngoplasty on leptin and endothelial function in sleep apnea.Ann Otol Rhinol Laryngol,2014,123(1):40-46.
[20]叶京英,李京京.阻塞性睡眠呼吸暂停低通气综合征的干预指征及治疗方法.中国临床医生,2013,41(7):468-471.
[21]Carpagnano GE,Spanevello A,Curci C,Salerno F,Palladino GP,Resta O,Di Gioia G,Carpagnano F,Foschino Barbaro MP.IL-2,TNF-alpha,and leptin:local versus systemic concentrations in NSCLC patients.Oncol Res,2007,16(8):375-381.
[22]曹淑芳,谭瑞星,黄冬薇.OSAHS患者呼出气冷凝液和血清中去甲肾上腺素、瘦素水平检测的临床意义.中国实验诊断学,2014,18(7):1098-1101.
[23]王胜国,周本忠,孙敬武,胡勇,李皓,兰兰.阻塞性睡眠呼吸暂停低通气综合征患者咽部组织中瘦素受体表达的研究.中华耳鼻喉头颈外科杂志,2005,40(10):787-788.