天津医药

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OSAHS患者正压通气治疗后促红细胞生成素及血液流变学的变化

董凯峰   

  1. 河北医科大学第一医院
  • 收稿日期:2013-11-05 修回日期:2014-05-12 出版日期:2014-08-15 发布日期:2014-08-15
  • 通讯作者: 董凯峰

Changes of Erythropoietin and Hemorheology in OSAHS Patients under Positive Pressure Ventilation Intervention

Kaifeng DONG   

  • Received:2013-11-05 Revised:2014-05-12 Published:2014-08-15 Online:2014-08-15
  • Contact: Kaifeng DONG

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摘要： 【摘要】目的   观察中重度阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome, OSAHS）患者经无创正压通气(noninvasive positive pressure ventilation,NPPV)治疗后血清促红细胞生成素（erythropoietin, EPO）及血液流变学变化的情况；进一步了解睡眠呼吸暂停低通气综合征对人体的影响。方法  选择32例诊断为中重度OSAHS患者在经无创正压通气治疗前、治疗1月及治疗3月后行多导睡眠监测、血清EPO及血流变检测，分析治疗前后不同时间夜间最低血氧饱和度（LSaO2）、患者血清EPO及血流变水平变化，并对其临床意义进行探讨。 结果   ①治疗3月后OSAHS患者全血粘度、血浆粘度、全血还原粘度、红细胞积聚指数、RBC、Hgb、HCT、MCH、MCV、血清EPO、LSaO2比治疗前均有差异，有统计学意义（P﹤0.05），而与对照组比较均无显著性差异（P＞0.05），上述所有指标治疗前与正常对照组均有明显差异，有统计学意义（P﹤0.05）。②治疗1月后OSAHS患者全血粘度、血浆粘度、全血还原粘度、红细胞积聚指数与治疗前比较无显著差异（P＞0.05）；而患者RBC、Hgb、HCT、MCH、MCV、LSaO2及血清EPO与治疗前相比有明显差异，有统计学意义（P﹤0.05），与治疗3月及对照组比较无显著差异（P＞0.05）。③相关性分析显示OSAHS患者治疗前后血清EPO水平与Hgb浓度、RBC均呈正相关(均P<0. 01) 。治疗前后AHI与血清EPO水平呈正相关(均P<0. 01) ，夜间LSaO2与血清EPO水平呈负相关（P＜0.05)。结论   OSAHS患者缺氧可诱发促红细胞生成素升高，血液粘度增加，通过无创正压通气治疗可以明显改善患者缺氧程度，使促红细胞生成素降低，降低血液粘度，所以早期检测并应用无创正压通气治疗以缓解气道阻塞对于防治OSAHS及其并发症具有重要的临床意义。

关键词: 无创正压通气, 阻塞性睡眠呼吸暂停低通气综合征, 促红细胞生成素, 血液流变学, 血氧饱和度

Abstract: [Abstract]  Objective   To observe erythropoietin (EPO) changes in severe obstructive sleep apnea hypopnea syndrome (OSAHS) patients after the noninvasive positive pressure ventilation (NPPV) treatment ;then learn more about the effects of sleep disorders on the human body. Methods   32 cases were diagnosed as moderate to severe obstructive sleep apnea hypopnea syndrome with noninvasive positive pressure ventilation, 1 and 3 months later sleep monitoring and serum erythropoietin detection were executed, sleep apnea hypopnea index (AHI), sleep mean minimum oxygen saturation (LSaO2) and serum erythropoietin (EPO) levels , and its clinical significance were analysised. Results   ① After the treatment of 3 months in patients with OSAHS whole blood viscosity , plasma viscosity, whole blood reduced viscosity, erythrocyte accumulation index , RBC, Hgb, HCT, MCH, MCV, the serum EPO, LSaO2 compared with the prior treatment ，the difference was statistically significant ( P <0.05), while compared with the control group showed no significant difference (P> 0.05), all of the above indicators in the prior treatment and control group were significantly different (P <0.05). ②after treatment for 1 month ，whole blood viscosity , plasma viscosity, whole blood reduced viscosity, erythrocyte accumulation index compared with the prior treatment had no significant difference (P> 0.05); while patients’ RBC, Hgb, HCT, MCH, MCV, LSaO2 and serum EPO compared with the prior treatment ,the difference was statistically significant (P <0.05), treatment for 3 months and the control group had no significant difference (P> 0.05). ③ Correlation analysis showed that OSAHS patients(before and after treatment)serum EPO levels and Hgb concentration , RBC were positively correlated ( all P <0. 01). AHI and serum EPO levels were positively correlated ( all P <0. 01), serum EPO levels and night LSaO2 with negatively correlated (P <0.05). Conclusion   OSAHS patients with hypoxia could induce erythropoietin increased，noninvasive positive pressure ventilation therapy can significantly improve AHI, LSaO2 , reduce the level of erythropoietin then further to reduce blood viscosity, so the early application of noninvasive positive pressure ventilation could relieve airway obstruction and its complications，for the prevention and treatment of OSAHS.

Key words: Non-invasive positive pressure ventilation, OSAHS, EPO, hemorheology, oxygen saturation