【作者】 翁永彩；

【导师】 刘吉祥；

【作者基本信息】 天津医科大学 ， 耳鼻咽喉科学， 2008， 硕士

【摘要】 目的:探讨阻塞性睡眠呼吸暂停低通气综合征（Obstructive Sleep ApneaHypopnea Syndrom,OSAHS）患者超敏C-反应蛋白（high sensitive C-creativeprotein,hs-CRP）的变化及肥胖对于这种变化的影响,同时探讨悬雍垂腭咽成形术（uvulopalatopharyngoplasty,UPPP）对OSAHS患者血清超敏C-反应蛋白的变化的影响。方法:选择经过我院多导睡眠图检查并根据中华医学会耳鼻咽喉分会2002年杭州会议标准确诊的20例适合行UPPP手术的OSAHS患者做为实验组,同时选取20例单纯肥胖的病人及20例健康人作为两个对照组,进行对照研究。实验血术前空腹取肘静脉血3 ml,采用免疫比浊法测定血清中的超敏C-反应蛋白,常规测量体重、身高,术后三个月再次复查PSG监测及血清C-反应蛋白的水平。结果:1、OSAHS组和单纯肥胖组除体重指数（BMI Body Mass Index）值无明显差异（p＞0.5）外,hs-CRP及睡眠监测各项参数包括呼吸暂停低通气指数（AHI apnea hypopnea index）、夜间最低SaO₂及平均SaO₂均有明显差异（P＜0.05）,而单纯肥胖组和正常组之间在BMI值和hs-CRP上的差异具有明显的统计学意义（P＜0.05）,OSAHS组和正常组的hs-CRP、BMI、AHI、夜间最低SaO₂及平均SaO₂差异均有统计学意义（P＜0.05）;OSAHS组的hs-CRP值与AHI之间存在明显正相关性（t=0.485,P＜0.05）;hs-CRP值与平均SaO₂存在负相关性（t=-0.506,P＜0.05）。2、UPPP手术术后三个月80%的患者自觉症状改善,检查见所有OSAHS患者的咽腔狭窄情况明显好转,未出现咽部明显的局部炎症反应。术后的hs-CRP值明显低于术后（r=4.818,P＜0.001）,术后三个月患者的AHI值出现明显的下降（r=10.01,P＜0.001）,夜间最低SaO₂及平均SaO₂均出现明显的提高。18例患者术后的AHI值较术前降低了60%以上,其中有16例患者的CRP值术后降低了40%以上,2例患者术后的的CRP值未见降低,反而有所升高。2例患者的AHI值仅降低12%和9%,其术后的hs-CRP值也未发生明显的变化。结论:1、OSAHS患者及单纯肥胖者的血清hs-CRP含量都明显高于正常者,而C-反应蛋白（C-reactive protein,CRP）是目前最有价值的急性时相反应蛋白,可以说明肥胖患者的hs-CRP的水平增高可能与肥胖本身处于慢性炎症状态有关。同时也提示OSAHS组hs-CRP水平的提高可能与呼吸暂停及上呼吸道的炎症有关。2、OSAHS患者行UPPP手术后血清中的hs-CRP水平含量明显下降,说明UPPP手术可以通过解除部分上呼吸道阻塞而改善上气道的夜间低氧状态和睡眠质量,炎症反应迅速减轻,UPPP除了降低AHI的同时可能可以通过局部的机制影响炎症,UPPP手术是一种治疗OSAHS患者有效的手术方法之一,可以大大降低OSAHS患者心血管疾病的发生率和死亡率。更多还原

【Abstract】 Objective:To explore the changes of the serum high sensitive C-creative protein level in patientse who have been diagnosised as OSAHS and the effect of fatness on this change.Meanwhile we will explore the effects of uvulopalatopharyngoplasty（UPPP）on high sensitive C-creative protein（hs-CRP）in serum of patients with obstructive sleep apnea hypopnea syndrome（OSAHS）.Method:We chose twenty patients as the experimental group who have been diagnosised as OSAHS and must be operated by UPPP after monitored by PSG in my hospital.Meanwhile we aslo chose twenty fat people without any other disease and twenty healthy people as two control groups.We compared these three groups in all index.The concentration of serum high sensitive C-creative protein（hs-CRP）level were measured with ELISA in the experimental group（n=20）and two control groups. The vein blood must be extracted before breaskfast in the morning.Three months after operation,OSAHS patients were monitored by PSG and serum high sensitive C-creative protein（hs-CRP）level were measured again.Result:1.BMI of The OSAHS group and that of the fatness group hsve no significant difference（P＞0.5）.But other index have significant difference （P＜0.05）.BMI and C-creative protein（hs-CRP）level of the fatness group and that of the healthy have significant difference（P＜0.05）.The OSAHS group and the healthy have significant difference in all index（P＜0.05）.Before treatment,there were significant positive correlation between hs-CRP and BMI in OSAHS patients （r=0.523,P＜0.01）.significant negative correlation between hs-CRP and AHI （r=0.485,P＜0.05）and significant positive correlation between CRP and the average SaO2(（r=-0.506,P＜0.05）.2.After UPPP eighty percents patients felt the symptom had changed.Stenosis of cavity of pharynx of all OSAHS patients had been improved.In general the serum level of crp of twenty OSAHS patients have reduced significantly after operation（r=4.818,P＜0.001）.The serum level of crp of sixteen patients had reduced fourty pecents,the level of two patients had not reduced,but heigntened on the contrary.Two patients had not changed significantly.On the other hand the AHI had reduced,it had statistical significance（r=10.01,P＜0.001）.The AHI eighteen patients had reduced more than 25 pecents,three patients had changed only 12 pecnets,9 pecnets. The effective power is 90 pecents.And the serum level of crp of the three patients were also not reduced.And the average SaO₂ at night and minimum SaO₂ were heightened.Tht the BMI had not changed.Conclusion:1.The serum hs-CRP level of OSAHS patients and fat people were significantly higher than healthy people.C-reactive protein is the most valueable acute protein.All these can show that the highten of The serum hs-CRP level of fat people may have correlation with chronic inflammation in the fatness,especially centripetal fatness.Meanwhile,it also show that t the highten of the serum hs-CRP level of OSAHS people may have correlation with inflammation in uper respiration tube and apnea hypopnea.2.After UPPP the serum hs-CRP level of OSAHS patients declined significantly,this can show that the UPPP can relieve the obstruction of part uper respiration tube to improve the estation of low oxyhgen at night and sleep quality,and then than inflammation reponse allleviate quickly.UPPP can recede the AHI, meanwhile it can effect inflammation by topical mechanism.We can see that the UPPP is one kind of efficiency operation method to treat the OSAHS,because it can decline obviously incidence and mortality of Cardiovascular Disease.更多还原