CPAP联合NAC雾化治疗中重度OSA患者血管内皮损伤的效果研究-现代医学

CPAP联合NAC雾化治疗中重度OSA患者血管内皮损伤的效果研究

单位：武汉科技大学附属普仁医院呼吸内科, 湖北武汉 430081

关键词：持续气道正压阻塞性睡眠呼吸暂停 N-乙酰半胱氨酸缺氧诱导因子-1α 内皮素-1

分类号：R563.9

出版年·卷·期（页码）：2022·50·第十一期（1419-1424）

摘要：

目的：探讨持续气道正压通气(CPAP)联合N-乙酰半胱氨酸(NAC)雾化治疗中重度阻塞性睡眠呼吸暂停(OSA)的临床价值，及其对OSA患者外周血HIF-1α、ET-1、NO表达的影响。方法：选取2019年12月至2021年8月在我院确诊的中重度OSA 125例、轻度OSA 120例及我院同期门诊体检中心筛选的健康者120例作为研究对象。中重度OSA根据治疗方案不同分为NAC组、CPAP组及联合组。所有入组者进行多导睡眠(PSG)监测和睡眠呼吸暂停生活质量指数(SAQLI)量表评估。收集各组外周血标本，采用酶联免疫吸附法检测血清HIF-1α及血浆ET-1水平，采用硝酸还原酶法检测血浆NO水平。结果：联合组治疗后的睡眠呼吸暂停低通气指数(AHI)比CPAP组下降更显著(P<0.05)；在日常活动、症状单项评分以及总分方面，联合组改善率明显高于CPAP组(P<0.05)；中重度OSA患者的HIF-1α及ET-1水平均与AHI呈正相关(r=0.832，P<0.05；r=0.795，P<0.05)，NO水平与AHI值呈负相关(r=-0.792，P<0.05)；联合组治疗后的HIF-1α、ET-1表达水平与NAC组、CPAP组治疗后比较均下降更为显著(P<0.05)，而NO表达水平上升更为显著(P<0.05)。结论：CPAP联合NAC雾化治疗可提高中重度OSA的临床疗效，明显改善患者生活质量，对中重度OSA血管内皮损伤可能有改善作用。

Objective: To investigate the clinical value of continuous positive airway pressure(CPAP) combined with N-acetyl cysteine(NAC) atomization in the treatment of moderate to severe obstructive sleep apnea(OSA) and its effect on the expression of HIF-1α, ET-1 and NO in peripheral blood of OSA patients. Methods: 125 patients with moderate to severe OSA, 120 with mild OSA, and 120 healthy subjects were recruited from December 2019 to August 2021 visited in our hospital. Moderate to severe OSA was divided into NAC group, CPAP group and combination groups. All enrollees underwent polysomnography(PSG) monitoring and sleep apnea quality of life index(SAQLI) scale assessment. Peripheral blood samples of each group were collected, and serum HIF-1α and plasma ET-1 concentrations were measured by enzyme-linked immunosorbent assay, and plasma NO concentration was measured by nitrate reductase assay. Results: The apnoea hypopnea index(AHI) after treatment of the combination group decreased more significantly than that of the CPAP group(P<0.05). For the single item score of daily activities and symptoms, and the total score, the rate of improvement in the combination group were significantly higher than those in the CPAP group(P<0.05).Both HIF-1α and ET-1 levels were positively correlated with AHI values in moderate to severe OSA(r=0.832, P<0.05; r= 0.795, P<0.05), and NO levels were negatively correlated with AHI values(r=-0.792, P<0.05).The expression levels of HIF-1α and ET-1 in the combined group decreased more significantly than those in NAC group and CPAP group(P<0.05), while the expression of NO increased more significantly(P<0.05). Conclusion: CPAP combined with NAC atomization therapy can improve the clinical efficacy and the quality of life of patients with moderate to severe OSA, and it may improve vascular endothelial injury in moderate to severe OSA.

参考文献：

[1] 中国医师协会睡眠医学专业委员会，叶京英.成人阻塞性睡眠呼吸暂停多学科诊疗指南[J].中华医学杂志,2018,98(24):1902-1914.
[2] 中华医学会，肖毅.成人阻塞性睡眠呼吸暂停基层诊疗指南(2018年)[J].中华全科医师杂志,2019,18(1):21-29.
[3] RANDERATH W,VERBRAECKEN J,DE RAAFF C A L,et al.European Respiratory Society guideline on non-CPAP therapies for obstructive sleep apnoea[J].Eur Respir Rev,2021,30(162):210200.
[4] ORRÙ G,STORARI M,SCANO A,et al.Obstructive sleep apnea,oxidative stress,inflammation and endothelial dysfunction-an overview of predictive laboratory biomarkers[J].Eur Rev Med Pharmacol Sci,2020,24(12):6939-6948.
[5] WU H,LV Q,ZHANG H,et al.The reduction of apnea-hypopnea duration ameliorates endothelial dysfunction,vascular inflammation,and systemic hypertension in a rat model of obstructive sleep apnea[J].Sleep Breath,2019,23(4):1187-1196.
[6] XIONG M,ZHAO Y,MO H,et al.Intermittent hypoxia increases ROS/HIF-1α related oxidative stress and inflammation and worsens bleomycin-induced pulmonary fibrosis in adult male C57BL/6J mice[J].Int Immunopharmacol,2021,100(11):108165.
[7] MORAND J,BRIANÇON-MARJOLLET A,LEMARIE E,et al.Zinc deficiency promotes endothelin secretion and endothelial cell migration through nuclear hypoxia-inducible factor-1 translocation[J].Am J Physiol Cell Physiol,2019,317(2):C270-C276.
[8] FENG Y,LI Q,WU Y,et al.Blocking C/EBP β protects vascular endothelial cells from injury induced by intermittent hypoxia[J].Sleep Breath,2019,23(3):953-962.
[9] LIU Y,WEN B,ZHANG F,et al.Effects of blood oxygen saturation on pulmonary artery remodeling in an in vitro perfusion circuit model[J].J Thorac Dis,2021,13(4):2169-2176.
[10] XIONG T,ZHANG Z,ZHENG R,et al.N-acetyl cysteine inhibits lipopolysaccharide-induced apoptosis of human umbilical vein endothelial cells via the p38MAPK signaling pathway[J].Mol Med Rep,2019,20(3):2945-2953.
[11] ALDURAYWISH A A.Cardiorespiratory and metabolic fitness indicators in novice volleyball trainees:effect of 1-week antioxidant supplementation with N-acetyl-cysteine/zinc/vitamin C[J].Int Med Res,2021,49(12):3000605211067125.
[12] 班健,罗雁,韦圳原,等.OSAHS患者相关炎性因子的表达与动脉粥样硬化的相关性分析[J].分子诊断与治疗杂志，2020,12(11):1522-1526.
[13] LIU C,WANG H,ZHU C,et al.Plasma expression of HIF-1alpha as novel biomarker for the diagnosis of obstructive sleep apnea-hypopnea syndrome[J].Clin Lab Anal,2020,34(12):e23545.
[14] LIN G,CHEN Q,HUANG J,et al.Effect of continuous positive airway pressure on endothelin-1 in patients with obstructive sleep apnea:a meta-analysis[J].Eur Arch Otorhinolaryngol,2019,276(3):623-630.
[15] LI X,WEI X,CHEN C,et al.N-Acetylcysteine inhalation improves pulmonary function in patients received liver transplantation[J].Biosci Rep,2018,38(5):BSR20180858.
[16] JIANG Y Q,XUE J S,XU J,et al.Efficacy of continuous positive airway pressure treatment in treating obstructive sleep apnea hypopnea syndrome associated with carotid arteriosclerosis[J].Exp Ther Med,2017,14(6):6176-6182.
[17] BROŻYNA-TKACZYK K,MYŚLIŃSKI W,MOSIEWICZ J.The assessment of endothelial dysfunction among OSA patients after CPAP treatment[J].Medicina(Kaunas),2021,57(4):310.

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