目的 检测阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血清一氧化氮(NO)、内皮素-1(ET-1)、血管性血友病因子(vWF)及肱动脉内径变化;评估连续气道正压通气(CPAP)对此类患者血管内皮功能的影响.方法 选择OSAHS患者55例和健康对照组55例,分别测定所有受试者血清NO、ET-1、vWF水平,同时使用多普勒彩超测定肱动脉内径变化.对OSAHS患者使用CPAP治疗3月后再次测定以上指标.结果 治疗前OSAHS患者血清NO水平和肱动脉内径变化率明显低于对照组(P均<0.01);血清ET-1和vWF水平明显高于对照组(P均<0.01).NO水平和肱动脉内径变化率与呼吸紊乱指数呈显著负相关(r分别为-0.621,-0.581,P<0.01),与最低血氧饱和度正相关(r分别为0.516,0.613,P<0.0I);ET-1和vWF水平与呼吸紊乱指数呈正相关(r分别为0.534,0.559,P均<0.01),与最低血氧饱和度均呈负相关(r分别为-0.479,-0.637,P均<0.01).肱动脉内径变化率与NO呈正相关,与ET-1和vWF水平呈负相关(r分别为0.681,-0.541和-0.513,P均<0.01).结论 OSAHS患者早期已存在血管内皮功能损害,与呼吸紊乱指数和低氧相关;CPAP能够改善患者血管内皮功能.%Objective To study the variety of NO, ET-1, vWF, and the internal diameter of brachial artery in patients with obstructive sleep apnea hypopnea syndrome(OSAHS). To assess the efficacy of continuous positive airway pressure (CPAP) in the treatment of vascular endothelium function with OSAHS. Methods OSAHS group(n =55)andcontrol group(n =55) were recruited in the study. The states of vascular endothelium function were evaluated by ultrasonic imagingmethod and the levels of serum NO,ET-1 ,and vWF in both group. Vascular endothelium function were reassessed in OSAHS patients after 3 months of CPAP treatment. Results Compared to the control group, the level of serum NO and brachial artery reactive hyperemia were significantly decreased in patients with OSAHS( P ＜ 0. 01 ). The levels of serum ET-1 and vWF were significantly higher in patients with OSAHS( P ＜0.01 ). The level of serum NO and brachial artery reactive hyperemia were negatively correlated to apnea hyponea index (AHI) ( r = - 0.621, - 0.581 ), which were positively related to the lowest SaO2 ( r = 0.516,0.613 ). The levels of serum ET-1 and vWF were positive correlation to AHI( r =0.534,0.559) ,which were negatively correlated to the lowest SaO2 ( r = - 0. 479, - 0.637 ) ( all P ＜ 0.01 ). Conclusion The injury of vascular endothelium function are existed in men OSAHS patients, and they are correlated to AHI and hypoxia during sleep. CPAP treatment can improve vascular endothelium function.
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