Department of Respiratory Medicine, P. J. Safarik University, Medical Faculty and L. Pasteur University Hospital, Kosice, Slovakia.
Physiol Res. 2018 Mar 16;67(1):69-78. doi: 10.33549/physiolres.933632. Epub 2017 Nov 10.
Circulating lipopolysaccharide-binding protein (LBP), a metabolic endotoxemia marker, was identified as an independent predictor of atherosclerosis. Although increases in carotid intima-media thickness (CIMT) were repeatedly reported in obstructive sleep apnea (OSA), neither the role of OSA in metabolic endotoxemia nor of LBP in early atherosclerosis were explored in patients with OSA. At a tertiary university hospital we investigated the relationships between OSA, LBP and CIMT in 117 men who underwent full polysomnography and CIMT assessment by B-mode ultrasound. Circulating LBP concentrations and average CIMT increased from patients without OSA to those with mild-moderate and severe OSA (from 32.1+/-10.3 to 32.3+/-10.9 to 38.1+/-10.3 microg.ml(-1), p=0.015; from 0.52+/-0.09 to 0.58+/-0.06 to 0.62+/-0.10 mm, p=0.004, respectively). Oxygen desaturation index (ODI) was a predictor of serum LBP levels independent of age, waist-to-hip ratio (WHR), smoking, hypertension, HDL cholesterol, triglycerides and fasting glucose [p (ANOVA)=0.002, r(2)=0.154], with no independent effect of the ODI*WHR interaction term on LBP. Furthermore, serum LBP predicted CIMT independently of known risk factors of atherosclerosis including obesity (p<0.001, r(2)=0.321). Our results suggest that OSA severity contributes to metabolic endotoxemia in patients with OSA independently of obesity, and that LBP might represent a contributing factor promoting early atherosclerosis in such patients.
循环脂多糖结合蛋白（LBP）是代谢性内毒素血症的标志物，被认为是动脉粥样硬化的独立预测因子。尽管阻塞性睡眠呼吸暂停（OSA）患者的颈动脉内膜中层厚度（CIMT）反复增加，但在 OSA 患者中，OSA 对内毒素血症的作用以及 LBP 在早期动脉粥样硬化中的作用尚未得到探讨。在一家三级大学医院，我们研究了 117 名男性患者的 OSA、LBP 和 CIMT 之间的关系，这些患者接受了全面的多导睡眠图检查和 B 型超声检查 CIMT 评估。循环 LBP 浓度和平均 CIMT 从无 OSA 患者增加到轻度至中度 OSA 患者和重度 OSA 患者（从 32.1±10.3 增加至 32.3±10.9 增加至 38.1±10.3 μg/ml，p=0.015；从 0.52±0.09 增加至 0.58±0.06 增加至 0.62±0.10 mm，p=0.004）。氧减指数（ODI）是独立于年龄、腰臀比（WHR）、吸烟、高血压、高密度脂蛋白胆固醇、甘油三酯和空腹血糖预测血清 LBP 水平的因素（p（ANOVA）=0.002，r(2)=0.154），ODI*WHR 相互作用项对 LBP 没有独立影响。此外，血清 LBP 可独立预测 CIMT，与动脉粥样硬化的已知危险因素（包括肥胖）有关（p<0.001，r(2)=0.321）。我们的结果表明，OSA 严重程度独立于肥胖，导致 OSA 患者的代谢性内毒素血症，而 LBP 可能是导致此类患者早期动脉粥样硬化的一个因素。
