摘要
目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者下丘脑-垂体-肾上腺轴和生长激素轴激素水平的变化及相互调节。方法对 OSAHS 患者(OSAHS 组)和单纯肥胖者(对照组)进行多导睡眠监测,应用酶联免疫吸附测定(ELISA)和放射免疫法测定睡前和睡后血浆促肾上腺皮质素释放激素(CRH)、促肾上腺皮质素(ACTH)、皮质醇、促生长素释放激素(GHRH)和生长激素(GH),分析其间的变化关系。结果与对照组比较,OSAHS 组患者 CRH、皮质醇明显升高[对照组睡前、睡后 CRH 分别为(0.67±0.42)、(2.27±1.10)mmol/L,OSAHS 组分别为(1.66±0.34)、(4.96±0.98)mmol/L;对照组睡前、睡后皮质醇分别为(68.94±20.13)、(146.05±30.48)μg/L,OSAHS 组分别为(152.93±136.15)、(445.53±123.09)μg/L;P 均<0.01];GHRH 降低[对照组睡前、睡后 GHRH 分别为(1.99±0.34)、(1.58±0.15)mmol/L,OSAHS 组分别为(1.42±0.07)、(1.01±0.05)mmol/L;P 均<0.05],而 GH 未表现明显差异(P>0.05);睡眠前后 CRH、GHRH 变化值之比(ΔCRH/ΔGHRH,285.02±143.32)也显著高于对照组(71.15±15.37,P<0.01);ΔCRH/ΔGHRH 与平均觉醒时间呈正相关(r=0.882),与平均血氧饱和度呈负相关(r=-0.696),平均血氧饱和度与平均觉醒时间呈负相关(r=-0.729)。结论 OSAHS 患者下丘脑-垂体-肾上腺轴和生长激素轴水平异常,反馈调节紊乱,并与睡眠觉醒和夜间低氧有关。
Objective To explore the regulation of hypothalamus-pituitary-adrenal （HPA） axis and growth hormone（GH） axis in obstructive sleep apnea-hypopnea syndrome （OSAHS）. Methods OSAHS patients（ OSAHS group） and subjects with obesity alone（ control group） were monitored by polysomnography （PSG）. The corticotropin-releasing hormone （CRH）, growth hormone releasing hormone （GHRH）, corticotropin （ACTH）, cortisol and growth hormone levels in plasma were measured by enzyme-linked immunosorbent assay （ELISA） and radioimmunoassay before and after sleep. Their correlation were analyzed. Results The CRH concentration [ （ 1.66±0.34 ）, （4. 9±0. 98 ） mmol/L before and after sleep] and cortisol content[ （152.93 ± 136. 15）, （445. 53 ±123.09）μg/L before and after sleep] in the OSAHS group were significantly higher than those of the control group [ CRH was （ 0. 67±0. 42 ）, （ 2. 27 ±1.10） mmol/L,cortisol concentration was（68.94±20. 13）, （ 146. 05±30. 48） μg/L, before and after sleep, respectively,all P 〈0. 01 ] ;GHRH significantly decreased in the OSAHS group[ （ 1.42±0. 07）, （ 1.01±0. 05） mmol/L before and after sleep ] compared with the control group [ （ 1.99 ± 0. 34 ）, （ 1.58±0. 15 ） mmol/L,respoctively; all P 〈0.01] ;but there was no difference in growth hormone. The ratio of the variation of CRH, GHRH level （ACRH/AGHRH） was significantly higher in the OSAHS group （285.02±143.32） than that in the control group（71.15±15. 37 ,P 〈0. 01 ）. The bivariate correlation analysis of the OSAHS group indicated that ACRH/AGHRH was correlated positively with average awake duration （ r =0. 882） ,but negatively with average blood oxygen concentration （ r = - 0. 696 ）. The average blood oxygen concentration was negatively correlated with average awake duration（ r = -0. 729）. Conclusions There are abnormal changes of HPA axis and GH axis in OSAHS patients, and the feedback regulation is disordered. These abnormalities are related to sleep structure variation and hypoxia during sleep.
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2006年第4期230-232,共3页
Chinese Journal of Tuberculosis and Respiratory Diseases
