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目的:了解持续气道正压通气(continuous positive airway pressure ventilation,CPAP)对阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患者晚期糖基化终末产物(advanced glycation end products,AGEs)及氧化低密度脂蛋白(oxidized low density lipoprotein,ox-LDL)水平的影响。方法:选取60例OSAHS作为病例组,30例单纯打鼾者作为对照组,对病例组患者给予为期4周的CPAP治疗,比较两组患者CPAP治疗前、后的血清AGEs和ox-LDL水平,并对病例组患者年龄、体重指数(BMI)、腰围、颈围及治疗前后的胰岛素水平、稳态模型评价(HOMA)指数、收缩压(SBP)、舒张压(DBP)、呼吸暂停低通气指数(AHI)、最低血氧饱和度(LSa O2)等临床指标进行测量和分析。结果:病例组患者血清AGEs水平、ox-LDL水平均高于对照组,差异有统计学意义(P<0.05)。经CPAP治疗后,病例组血清AGEs水平、ox-LDL水平均下降,与本组治疗前比较,差异有统计学意义(P<0.05),但仍高于对照组(P<0.05);经CPAP治疗后,病例组胰岛素水平、HOMA指数、SBP、DBP、AHI均下降,与治疗前比差异均有统计学意义(P<0.05)。多元线性回归分析显示,血清AGEs、ox-LDL均与AHI呈正相关,标准化回归系数分别为0.651、0.613;血清AGEs和ox-LDL均与LSa O2呈负相关,标准化回归系数分别为-0.528、-0.611。结论:OSAHS患者血清AGEs水平、ox-LDL水平升高,CPAP治疗能够改善临床症状并降低其血清AGEs、ox-LDL水平,降低氧化应激反应,调节代谢,从而降低其心脑血管发病风险。
OBJECTIVE: To investigate the effect of continuous positive airway pressure ventilation (CPAP) on advanced glycation end products (OSAHS) in patients with obstructive sleep apnea hypopnea syndrome , AGEs) and oxidized low density lipoprotein (ox-LDL). Methods: Sixty patients with OSAHS as the case group and 30 patients with simple snorers as the control group were enrolled. Patients in the case group were given CPAP for 4 weeks. The levels of serum AGEs and ox-LDL before and after CPAP were compared between the two groups The patients’ age, body mass index (BMI), waist circumference, neck circumference, insulin level before and after treatment, HOMA index, SBP, DBP and apnea hypopnea index AHI), the lowest oxygen saturation (LSa O2) and other clinical indicators were measured and analyzed. Results: Serum levels of AGEs and ox-LDL in case group were significantly higher than those in control group (P <0.05). After CPAP treatment, the level of serum AGEs and the level of ox-LDL in the patients decreased significantly compared with those before treatment (P <0.05), but still higher than those in the control group (P <0.05). After CPAP After treatment, insulin levels, HOMA index, SBP, DBP and AHI in the case group decreased compared with those before treatment (P <0.05). Multivariate linear regression analysis showed that serum AGEs and ox-LDL were positively correlated with AHI, with standardized regression coefficients of 0.651 and 0.613, respectively. Serum AGEs and ox-LDL were negatively correlated with LSa O2 with normalized regression coefficients of -0.528 and -0.528, respectively 0.611. CONCLUSIONS: Serum AGEs level and ox-LDL level are increased in patients with OSAHS. CPAP treatment can improve clinical symptoms and reduce serum levels of AGEs and ox-LDL, reduce oxidative stress response and regulate metabolism, thereby reducing the risk of cardiovascular and cerebrovascular diseases.