重度睡眠呼吸暂停低通气综合征患者尿促红细胞生成素排泄增加：持续气道正压通气的影响

Increased Urinary Erythropoietin Excretion in Severe Sleep Apnea-Hipoapnea Syndrome: The Effect of CPAP.

作者信息

Félez Miquel, Grau Nuria, Ruiz Antonia, Guardiola Encarna, Sanjuas Carles, Estirado Cristina, Navarro-Muñoz Maribel, Pascual Antoni, Orozco-Levi Mauricio, Gea Joaquim

机构信息

Unidad Multidisciplinar de Trastornos del Sueño, Hospital del Mar, Parc de Salut Mar, UAB-UPF, Barcelona, España; Servicio de Neumología, Hospital del Mar, Parc de Salut Mar, IMIM, UAB-UPF, CIBERES, ISC III, Barcelona, España.

出版信息

Arch Bronconeumol (Engl Ed). 2018 May;54(5):255-259. doi: 10.1016/j.arbres.2017.10.013. Epub 2017 Dec 6.

DOI:10.1016/j.arbres.2017.10.013

PMID:29217205

Abstract

INTRODUCTION

Tissue hypoxia stimulates the production of erythropoietin (EPO), the main effect of which is, in turn, to stimulate erythropoiesis. Sleep apnea-hypopnea syndrome (SAHS) is an entity characterized by repeated episodes of hypoxemia during sleep.

OBJECTIVE

To analyze whether hypoxemia stimulated increased urinary excretion of EPO, and if so, to evaluate if treatment with continuous positive airway pressure (CPAP) can inhibit this phenomenon.

METHODS

We studied 25 subjects with suspected SAHS who underwent a polysomnography study (PSG). EPO levels in first morning urine (uEPO) and blood creatinine and hemoglobin were determined in all patients. Patients with severe SAHS repeated the same determinations after CPAP treatment.

RESULTS

Twelve subjects were diagnosed with severe SAHS (mean ± SD, AHI 53.1 ± 22.7). Creatinine and hemoglobin levels were normal in all subjects. uEPO was 4 times higher in the SAHS group than in the control group (1.32 ± 0.83 vs. 0.32 ± 0.35 UI/l, p <.002). CPAP treatment reduced uEPO to 0.61 ± 0.9 UI/l (p <.02), levels close to those observed in healthy subjects. No dose-response relationship was observed between severity of PSG changes and uEPO values.

CONCLUSIONS

Patients with severe SAHS show increased uEPO excretion, but this normalizes after treatment with CPAP.

摘要

引言

组织缺氧会刺激促红细胞生成素（EPO）的产生，而EPO的主要作用反过来又是刺激红细胞生成。睡眠呼吸暂停低通气综合征（SAHS）是一种以睡眠期间反复出现低氧血症为特征的病症。

目的

分析低氧血症是否会刺激EPO尿排泄增加，如果是，评估持续气道正压通气（CPAP）治疗是否能抑制这种现象。

方法

我们研究了25名疑似SAHS的受试者，他们接受了多导睡眠图研究（PSG）。测定了所有患者晨尿中EPO水平（uEPO）以及血肌酐和血红蛋白水平。重度SAHS患者在CPAP治疗后重复相同测定。

结果

12名受试者被诊断为重度SAHS（均值±标准差，呼吸暂停低通气指数53.1±22.7）。所有受试者的肌酐和血红蛋白水平均正常。SAHS组的uEPO比对照组高4倍（1.32±0.83 vs. 0.32±0.35 UI/l，p<.002）。CPAP治疗使uEPO降至0.61±0.9 UI/l（p<.02），该水平接近健康受试者中观察到的水平。未观察到PSG变化严重程度与uEPO值之间的剂量反应关系。