Kobukai Yusuke, Koyama Takashi, Watanabe Hiroyuki, Ito Hiroshi
Department of Cardiovascular and Respiratory Medicine, Akita University Graduate School of Medicine, Akita, Japan.
Department of Cardiovascular and Respiratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
J Appl Physiol (1985). 2014 Nov 15;117(10):1141-8. doi: 10.1152/japplphysiol.00237.2014. Epub 2014 Sep 18.
This study investigated morning levels of pentraxin3 (PTX3) as a sensitive biomarker for acute inflammation in patients with obstructive sleep apnea (OSA). A total of 61 consecutive patients with OSA were divided into two groups: non-to-mild (n = 20) and moderate-to-severe (n = 41) OSA based on their apnea-hypopnea index (AHI) score. Those patients with moderate-to-severe OSA were further divided into continuous positive airway pressure (CPAP) treated (n = 21) and non-CPAP-treated (n = 20) groups. Morning and evening serum PTX3 and high-sensitivity (hs) C-reactive protein (CRP) levels were measured before and after 3 mo of CPAP therapy. The baseline hs-CRP and PTX3 levels were higher in patients with moderate-to-severe OSA than in those with non-to-mild OSA. Moreover, the serum PTX3 levels, but not the hs-CRP levels, were significantly higher after than before sleep in the moderate-to-severe OSA group (morning PTX3, 1.96 ± 0.52; evening PTX3, 1.71 ± 0.44 ng/ml). OSA severity as judged using the AHI was significantly correlated with serum PTX3 levels but not hs-CRP levels. The highest level of correlation was found between the AHI and morning PTX3 levels (r = 0.563, P < 0.001). CPAP therapy reduced evening and morning serum hs-CRP and PTX3 levels in patients with moderate-to-severe OSA; however, the reduction in PTX3 levels in the morning was greater than that in the evening (morning -29.8 ± 16.7% vs. evening -12.6 ± 26.8%, P = 0.029). Improvement in the AHI score following CPAP therapy was strongly correlated with reduced morning PTX3 levels(r = 0.727, P < 0.001). Based on these results, morning PTX3 levels reflect OSA-related acute inflammation and are a useful marker for improvement in OSA following CPAP therapy.
本研究调查了血清淀粉样蛋白3（PTX3）的晨起水平，作为阻塞性睡眠呼吸暂停（OSA）患者急性炎症的敏感生物标志物。根据呼吸暂停低通气指数（AHI）评分，将61例连续性OSA患者分为两组：非至轻度（n = 20）和中度至重度（n = 41）OSA。中度至重度OSA患者进一步分为持续气道正压通气（CPAP）治疗组（n = 21）和非CPAP治疗组（n = 20）。在CPAP治疗3个月前后，测量晨起和晚间血清PTX3以及高敏（hs）C反应蛋白（CRP）水平。中度至重度OSA患者的基线hs-CRP和PTX3水平高于非至轻度OSA患者。此外，在中度至重度OSA组中，睡眠后血清PTX3水平显著高于睡眠前，但hs-CRP水平并非如此（晨起PTX3，1.96±0.52；晚间PTX3，1.71±0.44 ng/ml）。使用AHI判断的OSA严重程度与血清PTX3水平显著相关，但与hs-CRP水平无关。AHI与晨起PTX3水平之间的相关性最高（r = 0.563，P < 0.001）。CPAP治疗降低了中度至重度OSA患者晚间和晨起血清hs-CRP和PTX3水平；然而，晨起PTX3水平的降低幅度大于晚间（晨起-29.8±16.7% vs.晚间-12.6±26.8%，P = 0.029）。CPAP治疗后AHI评分的改善与晨起PTX3水平的降低密切相关（r = 0.727，P < 0.001）。基于这些结果，晨起PTX3水平反映了与OSA相关的急性炎症，并且是CPAP治疗后OSA改善的有用标志物。
