| 【Blackground】As a common sleep disordered disease obstructive sleep apnea hyponoea syndrome(OSAHS) becomes more and more prevalent. A recent research revealed the new prevalence of OSAHS was 4.1% in our country. More and more research remaindered people that OSAHS had various complications, and with a prevalence 20-30% of complicating coronary artery disease(CAD). But the mechanism of how OSAHS complicating CAD is still unclear and there is no inflammatory mediator or factor that can be conceded the representation of the mechanism of how OSAHS complicating CAD. Previous researches claimed that OSAHS patients with recurrent apnea or hyponoea followed hypoxia and hypercapnia, leading to systemic inflammation, autonomic nervous regulation disorders, endothelial dysfunction, hemodynamic change and fibrinolytic system dysfunction might be involved in cardiovascular disease mechanisms, but still not comprehensive enough to explain its pathogenesis. Recent research about CAD claimed that oxidative stress had closed relationship with atherosclerosis, pathogenesis might be started by inflammatory mediators, have several kinds of cells and their factors participated.And endothelial dysfunction inflammation might also be involved. So the answer of how OSAHS complicating CAD may be got after the relationship between cardiovascular disease mechanisms and oxidative stress in OSAHS patients being figured out. Previous studies revealed that the extent of atherosclerosis was followed by the levels of sCD40L in serum of CAD patients. There was a positive feedback between high expression of and redundant reactive oxygen specie(sROS).Expression of many kinds of inflammatory factor which have relationship with CAD(for instance ICAM-1,VCAM-1,IL-1,IL-8,TNF-α,ROS,VEGF, et al)can be triggered by sCD40L via CD40-CD40L, after that high expression of ROS, endothelial dysfunction and inflammation can be connected tightly. In a word, sCD40L was remaindered as an important index of development, degree of severity and prognosis of CAD. So it will be useful for know how OSAHS complicating CAD further by detecting the regularity of sCD40L in OSAHS patients'serum and making sure that the pathogenesis of sCD40L in OSAHS patients is the same as that in CAD patients.【Objective】To know the prognosis of how OSAHS complicating CAD further by detecting the regularity of sCD40L in OSAHS patients'serum before and after nCPAP treatment and making sure that the pathogenesis of sCD40L in OSAHS patients is the same as that in CAD patients.【Method】111 people who had been diagnosed or treated by sleep disordered care center in our hospital were detected levels of sCD40L, CRP and IL-6 in their serum. There were 93 men and 18 women whose age ranged from 47 years to 64 years, with mean age 55.9±4.86 years. 21 normal ones with AHI<5 were treated as the normal team and 22 CAD patients as the CAD team(AHI<5).35 OSAHS patients without CAD were treated as the OSAHS team and divided into mild OSAHS team(n=11), moderate OSAHS team(n=12) and severe OSAHS team(n=12)according to AHI. 33 OSAHS patients with CAD were treated as the OSAHS+CAD team and divided into mild OSAHS+CAD team(n=11), moderate OSAHS+CAD team(n=11) and severe OSAHS+CAD team(n=11)according to AHI. PSG was applied on all objects and indexes of sleep disorder were colleted. Object keep fasting for 12 hours the night when PSG was tested, 8 ml blood was collected in the next morning. After centrifuging serum was collected and preserved in-80℃.Serum indexes and PSG were tested on 23 severe OSAHS patients again after nCPAP treatment for 3 months. sCD40L , CRP and IL-6 were tested by using ELISA.【Results】Before treatment levels of sCD40L ( (4.54±0.83)ng/ml ) CRP ((2.16±0.74)ng/l)and IL-6((0.41±0.11)ng/l) in OSAHS team were higher than that in normal team(sCD40L((2.48±0.55)ng/ml) CRP ((0.70±0.12)ng/l)and IL-6 ((0.24 ±0.03)ng/l) (P<0.01). Before treatment levels of sCD40L((6.70±0.44)ng/ml),CRP ((2.95±0.25)ng/l)and IL-6((1.86±0.36)ng/l)in CAD team were higher than that in OSAHS team(sCD40L (4.54±0.83)ng/ml,CRP(2.16±0.74)ng/l ,IL-6(0.41±0.11)ng/l)(P<0.01).Before treatment levels of . sCD40L((8.0±1.19)ng/ml)and CRP ((3.69±1.23)ng/l)in OSAHS+CAD team were higher than that in CAD team(sCD40L((6.70±0.44) ng/ml)CRP ((2.95±0.25)ng/l))(P<0.01). Before treatment levels of sCD40L CRP IL-6 in OSAHS team had positive correlation with AHI, with r= 0.88 0.63 and 0.43 respectively . Before treatment level of sCD40L in severe OSAHS team((5.26±0.20)ng/ml) was higher than that in the moderate OSAHS team((4.60±0.37)ng/ml)(P<0.01). Before treatment level of sCD40L in moderate OSAHS team was higher than that in the mild OSAHS team((3.43±0.54)ng/ml)(P<0.01).And level of sCD40L in mild OSAHS team was higher than that in the normal team((2.48±0.55)ng/ml)(P<0.01). Level of CRP in severe OSAHS team ((2.98±0.22)ng/l)was higher than that in the moderate OSAHS team((1.65±0.54)ng/l)(P<0.01),but there no different between the moderate OSAHS team the mild OSAHS team((1.57±0.14)ng/l(P>0.05). Levels of CRP in the moderate OSAHS team and mild OSAHS were higher than that of normal team((0.70±0.12)ng/l) (P<0.01).Level of IL-6 in the severe OSAHS team ((0.46±0.13)ng/l)was higher that in the moderate OSHAS team((0.33±0.12)ng/l)(P<0.05),but there's no difference between the moderate team and the mild OSAHS((0.40±0.11)ng/l)(P>0.05).Before treatment levels of sCD40L in the severe OSAHS+CAD team ((9.43±0.58) ng/ml)was higher than that in the moderate OSAHS+CAD team ((7.69±0. 35)ng/ml)and the mild OSAHS+CAD team((6.87±0.55)ng/ml)(P<0.01). There's no difference between the level of sCD40L in the mild OSAHS+CAD team and that of CAD team. Before treatment levels of CRP in the severe OSAHS+CAD team ((5.19±1.04) ng/l)was higher than that in the moderate OSAHS+CAD team (( 2.96±0.13 ) ng/l(P < 0.01) ) and the mild OSAHS+CAD team((2.92±0.21)ng/l)(P<0.01).There's no difference among levels of CRP of CAD team the mild OSAHS+CAD team and the moderate OSAHS+CAD team .Before treatment levels of IL-6 in the severe OSAHS+CAD team ((2.28±0.12 )ng/l)was higher than that in the moderate OSAHS+CAD team ((1.87±0.21)ng/l)and the mild OSAHS+CAD team((1.66±0.35) ng/l)(P<0.01).There no difference among levels of IL-6 of CAD team the mild OSAHS+CAD team and the moderate OSAHS+CAD team . Levels of sCD40L CRP IL-6 in OSAHS +CAD team had positive correlation with AHI, with r= 0.94 0.67 and 0.51 respectively.Before treatment levels of sCD40L of all object had positive correlation with that of CRP IL-6, with r=0.72,0.51. Before treatment levels of sCD40L of OSAHS team had correlation with that of CRP IL-6, with r=0.79,0.27.After treatment level of all indexes had improvement except the severe OSAHS+CAD team(0.46±0.13)ng/l vs (0.39±0.11)ng/l (P>0.05).【Conclusion】1. These revealed OSAHS could trigger the promotion of sCD40L and CD40-CD40L on atherosclerosis.2. Soluble CD40 ligand can be used as an index of condition of OSAHS and tendency of OSAHS complicating CAD.3. Levels of CRP and IL-6 had weak correlation with condition of OSAHS. So levels of CRP and IL-6 would be unsuitable to be an index of condition of OSAHS and tendency of OSAHS complicating CAD.4. Nasal CPAP treatment not only could improve sleep respiratory function, but also could reduce risk of OSAHS complicating CAD and slow down the process of atherosclerosis in OSAHS patients with CAD. |
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