摘要:
探讨缺血修饰白蛋白(IMA)及C-反应蛋白(CRP)在阻塞性睡眠呼吸暂停低通气综合征(OSAHS)诊断、病情评估以及疗效评价中的意义.研究选取2016年1月至10月该院呼吸科收治的OSAHS患者97例,根据多导睡眠监测(PSG)结果分为轻度OSAHS组46例,中度OSAHS组31例以及重度OSAHS组20例,同时选取30例单纯打鼾者作为对照组.分别于治疗前以及连续气道正压通气(CPAP)治疗一个月后检测所有患者的血清IMA和CRP水平.结果表明:OSAHS组血清IMA和CRP浓度显著高于对照组(P<0.05),且OSAHS组血清IMA浓度与OSAHS病情程度显著相关(P<0.05),而与年龄、性别及BMI无关.经1个月的CPAP治疗后OSAHS组血清IMA和CRP显著下降(P<0.05).以66.5 U/L为临界值,血清IMA用于诊断OSAHS的敏感性为82.5%,特异性为86.7%,阳性预测值为95.2%,阴性预测值为60.5%.研究提示:血清IMA作为OSAHS的独立预测因素其水平和OSAHS的严重程度密切相关,对OSAHS的诊断、病情分析及疗效评价有一定临床意义;另外,OSAHS患者CRP显著增高,提示炎症反应可能参与了OSAHS的病理发展过程.%To investigate the clinical significance of ischemic modified albumin (IMA),C-reactive protein(CRP) in the diagnosis,disease assessment and evaluation of therapeutic efficiency of obstructive sleep apnea hypopnea syndrome (OSAHS),from January 2016 to October 2016,97 patients with OSAHS admitted in the pneumology Department of Nanjing First Hospital Affiliated to Nanjing Medical University were enrolled.The 97 patients were divided into mild OSAHS group (46 cases),moderate OSAHS group (31 cases) and severe OSAHS group (20 cases) mainly according to polysomnography (PSG).At the same time,30 cases of simple snorers were selected as control group.Serum levels of IMA and CRP were measured before receiving any treatment in all 97 OSAHS patients and 30 simple snorers.Serum levels of IMA and CRP were measured repeatedly after receiving one month standard continuous positive airway pressure (CPAP) treatment in 97 OSAHS patients.The results showed that the serum levels of IMA and CRP in group of OSAHS were significantly higher than those in the control group (P < 0.05).Serum IMA level in OSAHS group was significantly correlated with the severity of OSAHS (P < 0.05).After one month's CPAP treatment,the serum IMA and CRP of OSAHS group decreased significantly (P < 0.05).Taking 66.5 U/L as the cut-off value,the sensitivity of serum IMA in OSAHS diagnosis was 82.5%,the specificity was 86.7%,the positive predictive value was 95.2%,and the negative predictive value was 60.5%.The research indicated that serum IMA was an independent predictor of OSAHS,and its level was closely related to the severity of OSAHS,irrespective of age,sex and BMI.The level of serum IMA has some clinical significance in the diagnosis,disease assessment and evaluation of therapeutic efficiency of obstructive sleep apnea hypopnea syndrome(OSAHS).By the way,in the present study the elevated CRP in patients with OSAHS indicated that inflammatory response was involved in the pathological development of OSAHS.