成年男性睡眠呼吸暂停综合征患者血清内脏脂肪素的变化

目的 研究成年男性阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血清中内脏脂肪素(visfatin)水平的变化.方法 对73例习惯性打鼾成年男性行多导睡眠仪监测,根据呼吸暂停低通气指数(AHI)分为对照组(AHI＜5次/h,n=13)、轻度OSAHS组(AHI 5 ～ 20次/h,n=14)、中度OSAHS组(AHI 21 ～40次/h,n=15)和重度OSAHS组(AHI＞ 40次/h,n=31),采用酶联免疫吸附试验测定血清中visfatin水平.结果 ①不同严重度OSAHS组患者间血清visfatin表达水平有显著差异,且其水平随着疾病严重程度增加而升高(0.23±0.11)、(0.24±0.19)、(0.29±0.24)和(0.48±0.32) ng/mL,F=4.704,p=0.005)]；其中重度组visfatin水平高于对照组、轻度组和中度组(t=2.751,P=0.009;t =2.563,P=0.014;t =2.014,P =0.05).②visfatin水平与AHI、阻塞性睡眠呼吸暂停指数(OAI)、微觉醒指数、最低氧减持续时间以及血氧饱和度≤90％的时间占总监测时间的百分比(TS90)均呈显著正相关(P＜0.01),而与夜间最低血氧饱和度(LSPO2)呈显著负相关(r=-0.435,P＜0.01).③控制体质量指数(BMI)和颈围因素后的偏相关分析显示,visfatin水平与OAI呈显著正相关(r =0.253,P=0.033).④受试者工作特征( ROC)曲线分析显示,visfatin水平临界值为0.273 ng/mL时,区分OSAHS轻中度和重度的敏感度为77％、特异度为64％；ROC曲线下面积为0.733,95％ CI为0.609 -0.858(P =0.001).结论 成年男性OSAHS患者血清visfatin水平与疾病严重程度一致,血清visfatin水平升高与OSAHS的发病存在一定的关联性.

Serum visfatin levels in adult male patients with obstructive sleep apnea-hypopnea syndrome

Objective To investigate the levels of serum visfatin in adult male patients with obstructive sleep apnea-hypopnea syndrome(OSAHS).Methods Seventy-three adult males with habitual snoring received polysonmographic examinations.Based on apnea hypopnea index(AHI),patients were divided into control group(AHI<5/h,n=13),mild OSAHS group(AHI 5-20/h,n=14),moderate group(AHI 21-40/h,n=15) and severe OSAHS group(AHI>40/h,n=31).The serum visfatin levels were measured by ELISA.Results ①There were significant differences in the serum visfatin levels among groups,and the serum visfatin levels increased with the severity of OSAHS (0.23±0.11) ng/mL,(0.24±0.19) ng/mL,(0.29±0.24)ng/mL and(0.48±0.32) ng/mL,F=4.704,P=0.005)].The serum visfatin level in severe OSAHS group was significantly higher than those in control group,mild OSAHS group and moderate group(t=2.751,P=0.009;t=2.563,P=0.014;t=2.014,P=0.05).②Serum visfatin level was positively correlated with AHI,obstructive sleep apnea-index(OAI),micro-arousal index,duration of lowest oxygen desaturation and percentage of the total recorded time spent below 90% oxygen saturation level(TS90)(P<0.01),but was negatively correlated with lowest pulse oxygen saturation(LSPO2)(r=-0.435,P<0.01).③Partial correlation analysis revealed that the serum visfatin level was positively correlated with OAI(r=0.253,P=0.033) after adjustment for body mass index(BMI) and neck circumference.④Analysis of receiver operating characteristic(ROC) curve indicated that the cut-off value of serum visfatin was 0.273 ng/mL,and the sensitivity and specificity for differentiating mild and moderate OSAHS from severe OSAHS were 77% and 64% respectively.The area under the ROC curve was 0.733,and 95%CI was 0.609 to 0.858(P=0.001).Conclusion Serum visfatin level increases with the severity of OSAHS in adult males,and the elevation of serum visfatin is related to the prevalence of OSAHS.