Clinical Significance Of The Changes Of Nitric Oxide, Endothelin-1, α-granule Membrance Protein And Von Willebrand Factor In The Patients With Obstructive Sleep Apnea-hypopnea Syndrome

Objective: Obstructive sleep apnea–hypopnea syndrome(OSAHS) is a chronic respiratory sleep disease with repetitiveserious snoring,apnea–hypopnea,hypoxemia.It has been demon-strated that OSAHS was an independent risk for unstableangina,myocardial infarction and brain infarction.But there arefew reports on the mechanism of OSAHS with highcardiovascular and cerebrovascular events.So it is necessary toinvestigate the mechanism of cardiovascular and cerebrovas-cular events,which is the main cause of death in patients withOSAHS. It has been showned that repetitive episodic hypoxemia inOSAHS patients affects the balance between vasodilators andvasoconstrictors, which induces the imbalance of vascularinternal environment and dysfunction of endothelial cells.Thedysfunction of endothelial cells,being regarded as an importantrisky factor for artherosclerosis,increases lipid and inflammationcells infiltration, platelet adhesiveness and assemblage,hypercoagulable state, which are regarded as the basis ofOSAHS with high cardiovascular and cerebrovascular 4英 文 摘 要events.But it is unknown whether the enhance of the morbidityand mortality of cardiovascular and cerebrovascular events inpatients with OSAHS is associated with dysfunction ofendothelial cells.This study evaluated whether dysfunction ofendothelial cells,activation of platelet and blood coagulationplay an important role in prevalence of cardiovascular andcerebrovascular events in order to search indirectly the mecha-nism of these events in patients with OSAHS before and afterusing nasal continuous positive airway pressure (nCPAP) bymeasuring the changes of venous plasma(serum) concentrationsof nitric oxide(NO),endothelin-1(ET-1),α-granule membranceprotein (GMP-140) and von willebrand factor (VWF), which aremarkers of endothelial function.We further investigated whethernCPAP therapy could correct the dysfunction of endothelialcells so that searching more effective and extensive methods forpatients with moderate/severe OSAHS. Methods: All subjects were recruited from the departmentof respiratory internal medicine at the second hospital of Hebeimedical university from October 2002 to December 2003,excluding acute infection,cerebral infarction,ischemic heartdisease,diabetes mellitus,rheumatism and rheumatoid disease,blood disease,hyperlipemia.They didn't use anticoagulantwithin two weeks and didn't have tea and coffee in twelvehours.The diagnosic standard of OSAHS came from THEINSTRUCTION OF DIAGNOSIS AND TREATMENT WITHOSAHS.Forty-six cases diagnosed as OSAHS by polysomn- 5英 文 摘 要ography(PSG) were selected as trial group,20 cases who hadAHI < 5 were as control group, ten moderate/severe OSAHSpatients were treated by nCPAP and taken as nCPAP therapygroup.All samples were collected in five minutes after wakingin early morning.GMP-140 and VWF were measured by ELISA,ET-1 was measured by RIA,NO was measured by GRIESS. Results: 1.In mild OSAHS patients, the levels ofcirculating NO,ET-1,GMP-140 and VWF were (65.88±14.84)umol/l,(38.97±9.11)pg/ml,(16.24±2.20)ng/ml and (148.91±19.74)% respectively. In control group,the values were (69.03±16.74)umol/l,(37.19 ± 8.23)pg/ml,(15.79 ± 1.55)ng/ml and(143.03±21.7.3) % respectively.There were no statistic signifi-cant differences in two groups. 2. In moderate/severe OSAHSpatients, the values of ET-1,GMP-140 and VWF were (61.49±12.29) pg/ml, (24.17 ± 2.69) ng/ml and (184.34 ± 32.37)%respectively, which were significant higher than that of the20 control subjects. The levels of serum NO was (40.67±14.54)umol/l, which was significant lower than that of the 20control subjects. 3. In nCPAP therapy group,the plasma levels ofGMP-140,VWF and ET-1 were significant lower after nCPAPtreatment in next night than that before nCPAP treatment,whilethere was a significant increasing in ser...