The Change And Its Correlation Analysis Of Plasma Adiponectin, Norepinephrine, Homocysteine Levels In Patients With Overlap Syndrom

Objective：By detecting plasma adiponectin, norepinephrine and homocysteinelevels in patients with chronic obstructive pulmonary disease(COPD), obstructivesleep apnea hypopnea syndrome(OSAHS) and overlap syndrome(OS). To analysis thecorrelation with disease severity and blood oxygen, and explore their role in deseasedevelopment. To explore the change of pathophysiology in patients with overlapsyndrome and its complications in order to provide new ideas for its prevention.Methods：By adopting cross methods, choose patients of our respiratory in theoutpatients and inpatients from May2012to October2013, those who have sleepsnoring and daytime sleepiness, Given polysomnography(PSG) monitoring andpulmonary function tests. The standard of OSAHS and COPD diagnosis according todiagnostic standard formulated by Chinese Medical Association. OSAHS accordingto AHI classification, severe(AHI≥30), moderate(15≤AHI＜30), mild(5≤AHI＜15)，sleep apnea(AHI＜5). All patients divided into six groups, including OS24cases,COPD26cases, sleep apnea24cases, mild OSAHS28cases, moderate OSAHS26cases, severe OSAHS32cases. Total160patients, male134and female26.Age(54.19±13.79), BMI(25.30±4.18)kg/m2. Exclude obesity hypoventilationsyndrome, interstitial pneumonia, severe liver and kidney disease, other heart diseaseexpect the cor pulmonale, secondary hypertension, severe arrhythmia and heartfailure, cerebrovascular disease, connective tissue disease, malignant tumors, variousacute or chronic infection has not yet been controlled, using sedation or centralexcited drugs or drug withdrawal less than1week, alcoholics and patients ofnoninvasive ventilation contraindicated. There were no significant differences ingender and age(P＞0.05). Smoking, drinking, diet, drugs and oher disturbance factorswere excluded.Fasting venous blood were obtained from all patients in the next morning onanticoagulant tube. The plasma adiponectin, norepinephrine, homocysteine weremeasured by ELISA. At the same time, height, weight, blood pressure before sleeping, and record apnea hypopnea index, the lowest oxygen saturation. Plasam adiponectin,norepinephrine and homocysteine levels were compared respectively among allgroups. Amd analyze the correlations between the three factors and sleep-breathingparameters, blood pressure before sleeping in all groups.Results：1. Plasma adiponectin concentration: OS was0.992±0.400ng/ml, mildOSAHS was3.727±1.048ng/ml, moderate OSAHS was2.679±0.528ng/ml, severeOSAHS was1.396＋0.404ng/ml, COPD was2.780±0.963ng/ml, sleep apnea was8.348±2.427ng/ml. The plasam adiponectin was lower in OS and each OSAHS groupthan sleep apnea(P＜0.01), There were statistical significances among each OSAHSgroup(P＜0.05), but no statistical significances between COPD and moderateOSAHS group(P＞0.05).2. Plasma noradrenaline concentration: OS was12.485±3.154ng/ml, mildOSAHS was4.074±0.548ng/ml, moderate OSAHS was6.072±0.973ng/ml, severeOSAHS was9.128±1.239ng/ml, COPD was6.077±1.767ng/ml, sleep apnea was2.665±0.523ng/ml. The plasam noradrenaline was higher in OS and each OSAHSgroup than sleep apnea(P＜0.01). There were statistical significances among eachOSAHS group(P＜0.05), but no statistical significances between COPD andmoderate OSAHS group(P＞0.05).3. plasam homocysteine concentration: OS was23.84±5.65μmol/l, mild OSAHSwas11.89±2.16μmol/l, moderate OSAHS was13.41±3.19μmol/l, severe OSAHS was17.66±4.87μmol/l, COPD was14.09±5.39μmol/l, sleep apnea was9.67±3.77μmol/l.The plasam noradrenaline was higher in OS and each OSAHS group than sleepapnea(P＜0.01). There were no statistical significances between COPD andmild-to-moderate OSAHS group and between mild and moderate OSAHS group(P＞0.05).4. PSG monitoring indicators and clinical indicators:①The lowest SaO2at nightwere lower in OS and severe OSAHS patients(P＜0.05).②Systolic blood pressurebefore beding has not statistical significances among all groups, but has statisticalsignificances in diastolic blood pressure between OS, moderate-to-severe OSAHSand mild OSAHS(P＜0.05).③Neck circumference has statistical significancesbetween OS and OSAHS, sleep apnea(P＜0.05).④There were statistical significances between OS, severe OSAHS and other groups(P＜0.05).5. Plasma adiponectin, norepinephrine, homocystein and correlation analysis: Theplasma adiponectin levels were correlated negatively with AHI(r=0.524,P＜0.01),were correlated positively with LSaO2(r=0.627,P＜0.01), while plasma noradrenalineand homocystein levels were correlated positively with AHI(r=0.484,P＜0.01;r=0.402,P＜0.01), were correlated negatively with LSaO2(r=0.731,P＜0.01;r=-0.617,P＜0.01). Plasma adiponectin and homocystein levels were nocorrelation with systolic, diastolic blood pressure(r=0.143,P＞0.143,r=0.115, P＞0.05;r=0.191,P＞0.05; r=0.143,P＞0.05). Plasma noradrenaline were no correlated withsystolic blood pressure(r=0.128,P＞0.128), were correlated positively diastolic bloodpressure(r=0.240,P＜0.05).Conclusions：1. The plasma adiponectin of OS and each OSAHS group werelower, but norepinephrine and homocystein were higher, and OS is more serious, inOSAHS, which is associated with disease severity, and degree of hypoxia.2. Plasma adiponectin levels were correlated negatively with AHI,werecorrelated positively with LSaO2, Plasma noradrenaline and homocystein werecorrelated positively with AHI, were correlated negatively with LSaO2. noradrenalinelevels were correlated positively with diastolic blood pressure before going to bed.3. Obesity, neck circumference, waist circumference are risk factors for OS.