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目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血浆 IL-18水平与动脉粥样硬化的关系。方法选取就诊的男性 OSAHS 患者52例,年龄26～77岁,分为轻度组16例,中度组18例,重度组18例,另选对照组18例。对其中 OSAHS 组中20例中重度患者进行持续气道内正压(CPAP)治疗,并检测颈动脉内膜中膜厚度(IMT),测定血浆白细胞介素-18(IL-18)的水平。采用方差分析、配对 t 检验及 Pearson 相关分析进行统计学处理。结果轻度、中度和重度 OSAHS 组的 IL-18水平分别为(352±76)ng/L、(600±84)ng/L 和(798±110)ng/L,均明显高于对照组的(250±76)ng/L,且 OSAHS 各组间均有明显差别。重度 OSAHS 组颈动脉 IMT 较对照组和轻度 OSAHS 组明显增厚。血浆 IL-18水平与颈动脉 IMT、呼吸暂停低通气指数(AHI)呈显著正相关(r 值分别为0.486、0.865,P 均<0.001),与最低脉搏氧饱和度呈显著负相关(r=-0.664,P<0.001)。CPAP 治疗后OSAHS 患者血浆 IL-18水平明显降低,颈动脉 IMT 未见明显改变。结论 OSAHS 患者颈动脉 IMT 增厚,血浆 IL-18水平升高,两者密切相关。血浆 IL-18水平升高与 OSAHS 严重程度相关,OSAHS 相关炎症反应可能与动脉粥样硬化的进程相关。CPAP 治疗能够改善患者 AHI 和最低脉搏氧饱和度,降低血浆 IL-18水平。
Objective To investigate the relationship between plasma IL-18 level and atherosclerosis in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods Fifty-two male OSAHS patients aged 26-77 years were enrolled in the study. They were divided into mild group (n = 16), moderate group (n = 18), severe group (n = 18) and alternative control group (n = 18). 20 patients with moderate-severe OSAHS group were treated with continuous positive airway pressure (CPAP), carotid intima-media thickness (IMT) and plasma interleukin-18 (IL-18) levels were measured. ANOVA, paired t-test and Pearson correlation analysis were used for statistical analysis. Results The levels of IL-18 in OSAHS group were (352 ± 76) ng / L, (600 ± 84) ng / L and (798 ± 110) ng / L, respectively), which were significantly higher than those in control group (250 ± 76) ng / L, and there was a significant difference between OSAHS groups. The carotid IMT in severe OSAHS group was significantly thicker than that in control group and mild OSAHS group. There was a significant positive correlation between plasma IL-18 level and carotid IMT and AHI (r = 0.486,0.865, P <0.001, respectively), but negatively correlated with lowest pulse oxygen saturation (r = -0.664, P <0.001). The levels of IL-18 in plasma of OSAHS patients after CPAP treatment were significantly lower than those of normal controls. No significant changes were found in carotid IMT. Conclusions The carotid IMT in patients with OSAHS is thickened and the level of plasma IL-18 is increased, which are closely related to each other. Elevated plasma IL-18 levels are associated with OSAHS severity, and OSAHS-related inflammatory responses may be related to the progression of atherosclerosis. CPAP treatment can improve patients with AHI and pulse oxygen saturation, reduce plasma IL-18 levels.