Center for Pulmonary Vascular Disease Diagnosis and Treatment, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, P.R. China.
Respir Med. 2011 Oct;105(10):1557-64. doi: 10.1016/j.rmed.2011.05.010. Epub 2011 Jun 8.
This study, in optimally treated CAD patients with newly diagnosed OSA, focused on (1) The relationships between OSA and serum biomarkers of four potential pathways of cardiovascular injury in OSA: high-sensitivity C-reactive protein (hs-CRP), endothelin-1 (ET-1), N terminal pro B type natriuretic peptide (NT-proBNP) and fibrinogen; and (2) The effect of continuous positive airway pressure (CPAP) therapy on these markers. 151 Chinese patients with proven CAD and standard medication were enrolled. After polysomnography, patients were classified into four groups according to apnea-hypopnea index (AHI): no OSA (n = 25); mild OSA (n = 50); moderate OSA (n = 43); severe OSA (n = 33). Morning levels of hs-CRP, ET-1, NT-proBNP and fibrinogen were assayed and repeated in severe OSA patients after 3-months CPAP treatment. Hs-CRP was greater in patients with severe OSA than those with no OSA or mild OSA (P = 0.001, P = 0.003; respectively). After adjustment for confounders, the hs-CRP levels correlated most strongly with AHI and oxygen desturation index (ODI) (r = 0.439, P < 0.001; r = 0.445, P < 0.001; respectively). In stepwise multiple linear regressions, the strongest predictor of hs-CRP levels was ODI (P < 0.001). After 3 months of CPAP treatment, the hs-CRP levels deceased (P = 0.005) in CAD patients with severe OSA. In CAD patients on current optimal medications, hs-CRP is significantly correlated with the severity of OSA, and the elevated hs-CRP levels can be decreased by CPAP. This suggests that OSA could activate vascular inflammation in CAD patients despite current best practice medications.
这项研究针对的是经优化治疗的 CAD 患者中刚确诊的 OSA，重点关注（1）OSA 与四种潜在心血管损伤途径的血清生物标志物之间的关系：高敏 C 反应蛋白（hs-CRP）、内皮素-1（ET-1）、N 末端 pro B 型利钠肽（NT-proBNP）和纤维蛋白原；（2）持续气道正压通气（CPAP）治疗对这些标志物的影响。共纳入 151 例经证实的 CAD 患者和标准药物治疗。进行多导睡眠图检查后，根据呼吸暂停低通气指数（AHI）将患者分为四组：无 OSA（n=25）；轻度 OSA（n=50）；中度 OSA（n=43）；重度 OSA（n=33）。检测清晨 hs-CRP、ET-1、NT-proBNP 和纤维蛋白原水平，并在重度 OSA 患者中重复检测 3 个月 CPAP 治疗后的结果。与无 OSA 或轻度 OSA 患者相比，重度 OSA 患者的 hs-CRP 水平更高（P=0.001，P=0.003）。经混杂因素调整后，hs-CRP 水平与 AHI 和氧减指数（ODI）相关性最强（r=0.439，P<0.001；r=0.445，P<0.001）。逐步多元线性回归分析显示，hs-CRP 水平的最强预测因子是 ODI（P<0.001）。在重度 OSA 的 CAD 患者中，经过 3 个月 CPAP 治疗后，hs-CRP 水平降低（P=0.005）。在当前接受最佳药物治疗的 CAD 患者中，hs-CRP 与 OSA 的严重程度显著相关，CPAP 可降低升高的 hs-CRP 水平。这表明，尽管 CAD 患者接受了目前的最佳治疗药物，但 OSA 仍可激活血管炎症。
