持续气道正压通气治疗可抑制阻塞性睡眠呼吸暂停合并哮喘患者的炎性细胞因子并改善糖皮质激素反应性：一项病例对照研究。
Continuous positive airway pressure therapy suppresses inflammatory cytokines and improves glucocorticoid responsiveness in patients with obstructive sleep apnea and asthma: A case-control study.
作者信息
Mahboub Bassam, Kharaba Zelal, Ramakrishnan Rakhee K, Sharif Askari Narjes Saheb, Salameh Laila Ibraheem, Alhariri Hassan Saber, Vats Mayank G, Erabia Wafa Taleb, Alshawamreh Esra'a Mohammad, Alfoteih Yassen, Mogas Andrea K, Halwani Rabih, Hamid Qutayba
机构信息
Department of Respiratory and Sleep Medicine, Rashid Hospital, Dubai Health Authority, Dubai.
Tissue Injury and Repair Research Group, Sharjah Institute for Medical Research - College of Medicine, University of Sharjah, Sharjah.
出版信息
Ann Thorac Med. 2022 Jul-Sep;17(3):166-172. doi: 10.4103/atm.atm_37_22. Epub 2022 Jul 9.
CONTEXT
Asthma and obstructive sleep apnea (OSA) are prevalent respiratory disorders that frequently coexist. Continuous positive airway pressure (CPAP) therapy is the standard treatment for OSA. However, its effects on systemic inflammation and glucocorticoid responsiveness in OSA patients with asthma are largely unknown.
AIMS
To examine the potential role of CPAP therapy in reducing systemic inflammation and improving glucocorticoid responsiveness in asthmatic patients with OSA.
SETTINGS AND DESIGN
A case-control study was conducted at the respiratory and sleep clinics involving patients with OSA and patients with asthma and OSA.
METHODS
The levels of inflammatory asthma biomarkers (interleukin [IL]-4, IL-17A, IL-8, IL-2, and interferon-γ [IFN-γ]), and glucocorticoid receptors (GR)-α and GR-β, were determined to compare systemic inflammation and glucocorticoid responsiveness between pre- and post-1-month CPAP treatment in both groups.
STATISTICAL ANALYSIS
The Wilcoxon signed-rank test was used to compare inflammatory biomarkers before and after CPAP therapy. < 0.05 considered statistically significant. The analysis was performed using SPSS.
RESULTS
Recruited patients ( = 47), 51% ( = 24) had OSA and 49% ( = 23), had OSA with asthma. Interestingly, the blood levels of IL-17 and IL-8 were significantly decreased post-CPAP therapy in OSA patients, whereas IL-4, IL-17, and IFN-γ were significantly reduced post-CPAP treatment in OSA patients with asthma. Remarkably, CPAP therapy improved glucocorticoid responsiveness in asthmatic patients with OSA, but not in the OSA group and an increase in the GR-α/GR-β ratio was noted post-CPAP therapy.
CONCLUSIONS
Continuous positive airway pressure therapy improved responsiveness to glucocorticoid treatment and demonstrated a suppressive effect on proinflammatory cytokines in asthmatics with OSA.
背景
哮喘和阻塞性睡眠呼吸暂停（OSA）是常见的呼吸系统疾病，常同时存在。持续气道正压通气（CPAP）治疗是OSA的标准治疗方法。然而，其对合并哮喘的OSA患者全身炎症和糖皮质激素反应性的影响尚不清楚。
目的
探讨CPAP治疗在减轻合并哮喘的OSA患者全身炎症和改善糖皮质激素反应性方面的潜在作用。
设置与设计
在呼吸和睡眠诊所进行了一项病例对照研究，纳入了OSA患者以及哮喘合并OSA患者。
方法
测定炎症性哮喘生物标志物（白细胞介素[IL]-4、IL-17A、IL-8、IL-2和干扰素-γ[IFN-γ]）以及糖皮质激素受体（GR）-α和GR-β的水平，以比较两组患者在CPAP治疗1个月前后的全身炎症和糖皮质激素反应性。
统计分析
采用Wilcoxon符号秩检验比较CPAP治疗前后的炎症生物标志物。P<0.05被认为具有统计学意义。分析使用SPSS进行。
结果
共招募患者47例，其中51%（24例）患有OSA，49%（23例）患有哮喘合并OSA。有趣的是，CPAP治疗后，OSA患者的IL-17和IL-8血水平显著降低，而哮喘合并OSA患者的IL-4、IL-17和IFN-γ在CPAP治疗后显著降低。值得注意的是，CPAP治疗改善了哮喘合并OSA患者的糖皮质激素反应性，但在OSA组中未改善，且CPAP治疗后GR-α/GR-β比值增加。
结论
持续气道正压通气治疗改善了合并OSA的哮喘患者对糖皮质激素治疗的反应性，并对促炎细胞因子具有抑制作用。
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