Characteristic Of CysC, Hs-CRP And SOD In Hypertension Patients With Obstructive Sleep Apnea Hypopnea Syndrom

Objective: To study the levels of Cystain(Cys C), high sensitivity C reactive protein( hs-CRP), superoxide dismutase(SOD) in cases of obstructive sleep apnea hypopnea syndrome(OSAHS) related with hypertension and to explore their probable mechanisms and clinical values. And to analyze the effects of the treatment of nasal continuous positive airway pressure(CPAP) on the levels of Cys C, hs-CRP, SOD and blood pressure rhythm in hypertensive patients who related with OSAHS.Methods: The 147 cases were diagnosed with snoring in the departments of cardiology, snoring in Gansu Provincial People’s Hospital from December 2013 to December 2014 and recorded apnea hypopnea index(AHI), lowest oxygen saturation(LSa O2), and mean oxygen saturation(MSa O2) by monitoring Polysomnography(PSG) and blood pressure measurement. The subjects were divided into four groups,75 hypertension patients with OSAHS group(OH group), 32 patients with simple OSAHS group(O group), 40 cases of simple hypertension group(H group) and 40 healthy cases who came to the medical examination center of Gansu Provincial People’s Hospital(N group). Among all the subjects, we examined the body mass index(BMI), and recorded smoking history, drinking history, and family history and Epworth(Epworth sleepiness scale, ESS). Mean while, we extracted 3ml of intravenous blood before and after continuous positive airway pressure therapy and examined Cys C, hs-CRP and SOD levels in serum. Used Immunoturbidimetry to determinate the serum levels of Cys C(Normal value≤1.03mg/L), Particle enhanced transmitted immunoturbidimetry assay to determinate the serum levels of hs-CRP(Normal value ≤ 5mg/L), and Pyrogallol colorimetric method to determinate the serum levels of SOD(Reference range 129~216 U/m L). All statistical analyses were carried out using statistical software(SPSS, version 17.0 for Windows).Differences were considered significant at P<0.05.Results: 1. baseline data groups of each group: there is no significant difference in gender, age, smoking, alcohol consumption, body mass index, liver function, renal function results(P<0.05); PSG monitoring results: AHI significantly increased in OH group and O group, and LSa O2, MSa O2 decreased significantly; there was significant difference between H group and N group(P<0.05); OH group and H group had higher blood pressure than the other two groups; OH group had higher blood pressure, elevated AHI, the levels of LSa O2, MSa O2 decreased significantly than the other three groups, and the difference was statistically significant(P<0.05); 2. Comparison of serum Cys C, hs-CRP and SOD level among all the subjects: compared with the N group, in OH, O and H three groups the levels of serum Cys C, hs-CRP increased, and SOD decreased;in OH group patients, serum Cys C, hs-CRP increased and SOD decreased most significantly(P<0.05); compared patients in group OH and the two groups(O, H), there was significant difference in levels of serum Cys C, hs-CRP and SOD(P<0.05); the difference between O group and H group, the serum Cys C, hs-CRP and SOD level has no significant difference(P>0.05); 3. Comparison of PSG monitoring results before and after CPAP treatment for one month, serum Cys C, hs-CRP, SOD levels and blood pressure levels in 42 cases of severe OSAHS ssociated hypertension patients in OH groups treated with CPAP: AHI, serum Cys C, hs-CRP levels reduced after treatment, and the LSa O2, MSa O2, SOD levels increased(P<0.05); 4. The changes of blood pressure after CPAP treatment among OH group: the average systolic and diastolic blood pressure were significantly reduced after treatment(P<0.05), the night mean systolic and night mean diastolic blood pressure decreased most obviously(P<0.05); 5. Analysis of Pearson correlation of OSAHS associated hypertension subjects, the serum levels of Cys C, hs-CRP and SOD expressional level and PSG monitoring results: Cys C, hs-CRP was positively correlated with AHI(correlation index 0.757, 0.761); Cys C was negatively correlated with LSa O2,MSa O2(correlation index-0.730,-0.708); hs-CRP was negatively related to LSa O2 and MSa O2(correlationindex-0.734,-0.720, P<0.05). The expression level of SOD was negatively correlated with AHI(correlation index-0.709, P<0.05); and was positively related to LSa O2, MSa O2(correlation index 0.596, 0.606, P<0.05).Conclusions: 1. The hypertension patients with OSAHS has a higher serum levels of Cys C, hs-CRP and SOD, And this change may has certain clinical early warning role.2. OSHAS can lead to high blood pressure, and the hypertension patients with OSAHS is given priority on night blood pressure, the blood pressure circadian rhythm changes into non dipper type.3. The changes of serum Cys C, hs-CRP and SOD level to some extent can reflect the severity of apnea and the severity of hypoxia and low ventilation in patients with OSAHS during sleep.4. CPAP therapy can improve endothelial damage in patients of OSAHS related with hypertension, reduce the inflammatory response level, improve the ability of anti oxidative stress, decrease serum Cys C, hs-CRP levels in patients, increase SOD, lower blood pressure of patients with the OSAHS correlation to essential hypertension, and especially lower their night average systolic and diastolic blood pressure, and change blood pressure circadian rhythm to play certain role in clinical treatment.