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[摘要] 目的：探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者血清中瘦素、C反应蛋白水平（CRP）变化与OSAHS病情严重程度的关系，以及两因子在疾病中的相关性。方法：采用酶联免疫吸附法（ELISA）测定30例男性OSAHS患者[根据呼吸暂停低通气指数（AHI）将患者分为轻、中、重度三组]和20例健康者（对照组）血清瘦素、CRP水平，利用统计学方法，比较各组间的差异并分析瘦素与CRP的相关性。结果：①OSAHS组血清瘦素和CRP水平均较对照组有增高。②OSAHS组：自轻、中至重度组，瘦素水平逐渐增高，组间两两比较差异均有统计学意义。而CRP水平重度组较轻中度组有明显增高，轻中度之间差异无统计学意义。③相关分析表明：瘦素与AHI、CRP呈正相关。结论：OSAHS患者血清瘦素、CRP水平均较健康人明显增高，且与其严重程度相关。同时瘦素与CRP呈正相关，表明两者可能在OSAHS的发展过程中有协同作用。
[关键词] 阻塞性睡眠呼吸暂停低通气综合征；瘦素；C反应蛋白；酶联免疫吸附法
[中图分类号] R441.8；R563.8 [文献标识码]A[文章编号]1674-4721（2011）08（b）-０16－０2
The changes of serum leptin and CRP levels in patients with obstructive sleep apnea-hypopnea syndrome and the correlation
QIN Ruijun1,WANG Ping2*, WANG Hong2, QIAO Kehong2, MA Yanbing2, SHANG Xiaofeng2, ZHENG Shuguang2, GUO Changcheng2, YIN Huiting2, LI Hong2
Department of Respiratory Diseases, Central Hospital in Taiyuan City, Shanxi Province, Taiyuan, 030009, China
[Abstract] Objective: To investigate the relationship between the changes of serum leptin and C-reactive protein (CRP) levels in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and the severity of OSAHS, and to study two factors′correlation. Methods: Using enzyme-linked immunosorbent assay (ELISA) measured serum leptin and C-reactive protein (CRP) between 30 male patients with OSAHS [on the apnea-hypopnea index (AHI), the case group was divided into mild, moderate and severe] and 20 healthy persons (control group). And the differences between groups were compared and the correlation between leptin and CRP were analyzed by statistical methods. Results: ①Serum levels of leptin and CRP in OSAHS group were significantly higher than those in the control group. ②OSAHS groups: From mild to severe group, leptin levels gradually increased and the difference between two groups were statistically significant. The CRP level of severe group was significantly higher than moderate group, and there was no statistically significant difference between mild group and moderate group. ③Correlation analysis: Leptin and AHI, CRP was positively correlated. Conclusion: Serum leptin and CRP levels in OSAHS patients was significantly higher than those in healthy people, and serum leptin and CRP levels were correlated with the severity of OSAHS. Serum leptin and CRPwere positively correlated, indicating that both may have synergistic effect in the development of OSAHS.
[Key words] Obstructive sleep apnea－hypopnea syndrome; Leptin; C-reactive protein; Enzyme-linked immunosorbent assay
阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea－hypopnea syndrome，OSAHS）是睡眠期间由于反复发作呼吸暂停和（或）低通气，引起低氧血症、高碳酸血症，从而使机体发生一系列病理生理改变的临床综合征。国外资料显示，OSAHS在成年人中的患病率为2%~4%，是多种全身疾病的独立危险因素[1]。瘦素为脂肪细胞分泌的一种分泌型蛋白类激素，具有调节能量代谢、增加交感神经活性等作用，近年来它与OSAHS关联倍受国内外研究者关注。而C反应蛋白（CRP）是炎症的重要标志，研究证实它是诱发心血管疾病的危险因子，可能与OSAHS也有关联。本研究通过检测OSAHS患者血清中的两种因子水平，揭示两者与OSAHS及其严重程度的关系，同时探讨两种因子彼此的相关性，以了解两者在OSAHS的发展过程中是否有协同作用。
1 资料与方法
1.1 研究对象
病例组：选择2010年1～12月在本院呼吸内科睡眠监测中心就诊的OSAHS男性患者30例，年龄为38~74岁，BMI为23.1～34.6 kg/m2，均符合中华医学会呼吸病学分会睡眠呼吸疾病学组制定的诊断标准，并根据呼吸暂停低通气指数（AHI）将病例组分为轻、中、重度3组（轻度：AHI为5～20次/h；中度：AHI为21～40次/h；重度：AHI为＞40次/h）。其中轻度组12例，中度组8例，重度组10例。对照组：同期在本院健康体检，并经多导睡眠检测除外OSAHS（AHI 1.2 方法
1.2.1 多导睡眠监测（PSG）所有观察对象均接受多导睡眠监测仪（北京怡和嘉业医疗科技有限公司产品，型号：YH-2000A）至少7 h睡眠监测，记录呼吸暂停低通气指数（AHI）、夜间最低血氧饱和度（SaO2）、平均SaO2等指标。检测当天禁饮酒、咖啡及服镇静、催眠药。
1.2.2 瘦素、CRP测定所有观察对象于多导睡眠监测次日晨起空腹抽取静脉血5 ml，室温静置30 min后离心分离血清，-20℃冻存。用酶联免疫吸附法（ELISA）检测血清瘦素和CRP。其中瘦素的测定采用上海西唐生物科技有限公司生产的人瘦素ELISA试剂盒，CRP的测定采用上海西唐生物科技有限公司生产的人超敏C反应蛋白ELISA试剂盒。所有操作均严格按照试剂盒说明书进行。
1.3 统计学处理
应用SPSS 13.0统计软件进行统计分析，计量资料用均数+标准差（x±s）表示。两组间均数比较采用独立样本t检验。多组间均数比较采用单因素方差分析，组间两两比较采用LSD法比较。数据间的关系判断采用相关分析。以P [5]Eun YG,Kim MG,Kwon KH,et al．Short－term effect of multilevel surgery on adipokines and pro－inflammatory cytokines in patients with obstructive sleep apnea[J]．Acta Otolaryngol,2010,130(12):1394-1398．
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（收稿日期：2011-06-23）
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