|
Background with obstructive sleep apnea syndrome (OSAHS) in recent years gradually awareness and attention to the disease of middle-aged men in Western countries, the incidence rate of about 4%, the female is about 2%. With the year-on-year improvement of people's living standards, the increase in the number of obese patients and people with obstructive sleep apnea syndrome increased awareness, more cases were diagnosed, the actual incidence will increase further (According to statistics, more than 80% in the United States not get the diagnosis and treatment of patients with moderate to severe). If not for the treatment of obstructive sleep apnea syndrome, will lead to excessive daytime sleepiness, cognitive impairments, personality and mood changes, feelings between the decline in the quality of life and the couple injuries; addition, obstructive sleep apnea hypopnea syndrome or lead one of the important cause of traffic accidents, and a heavy burden on individuals, families, and society. Sleep apnea can cause hypoxia, carbon dioxide retention can also cause or aggravate hypertension, coronary artery disease, arrhythmias, heart failure, diabetes and insulin resistance, stroke. According to the American Heart Association in 2008, sleep apnea and cardiovascular disease expert consensus \specified sleep apnea and cardiovascular disease, type 2 diabetes, and even causality. Strengthen the treatment of sleep apnea and cardiovascular disease, the primary and secondary prevention of stroke, reduce stroke disability, reduce the burden on the society and the family has an extremely important role. According to statistics, the U.S. intervention untreated obstructive sleep apnea hypopnea syndrome annual medical costs of $ 3.4 million, obstructive sleep apnea hypopnea syndrome on the consumption of health resources for healthy people 2 times. Therefore, obstructive sleep apnea syndrome become affecting public health health career, the outstanding problems of the country's economic and social development, has caused widespread concern in many disciplines doctors. Ischemia-reperfusion injury is the focus of research in the last decade, the main point of reperfusion of ischemic tissue increased cell damage or tissue death, major reperfusion blood contains large amounts of harmful substances, when the tissue cells reperfusion, these harmful substances reach the bloodstream organization, resulting in the so-called \Ischemia-reperfusion harm not only can cause ischemia and reperfusion arrhythmias, myocardial systolic function, brain edema and cerebral necrosis, intestinal mucosal injury, acute renal injury, but also cause immune system disorders. Obstructive sleep apnea hypopnea syndrome due to sleep at night when repeated airway collapse led to a series of \Therefore, we have good reason to suspect obstructive sleep apnea hypopnea syndrome is also caused damage to the immune function. Hypoxia - reoxygenation and ischemia-reperfusion major hazards of this process is to produce large amounts of free radicals (ROS) and inflammatory cytokines (such as IL-6, TNF-α). Large amounts of oxygen free radicals and inflammatory factors can cause vascular endothelium, pancreas, heart, kidneys and other systemic damage. Sufficient proof of evidence-based medicine: obstructive sleep apnea hypopnea syndrome is considered a systemic disease, a risk factor for cardiovascular disease mortality, not only can lead to high blood pressure, coronary heart disease, arrhythmias, heart failure, diabetes and insulin resistance, stroke, may also cause damage to the immune function. Long study confirmed that patients with OSAHS body's normal immune function, especially The leukocyte system involved in the humoral and cellular immune function varying degrees of damage. Domestic Tan Yuhua research results are shown OSAHS patients and the control group significantly increased in comparison CD8, CD4 / CD8 decreased significantly; foreign Dyugovskaya L results was not OSAHS decline in the proportion of patients with CD4 cell and CD8 cell ratio rises, CD4 cells and CD8 cell activation have seen increases in the proportion of the decline in cellular immune function. Previous study sample size is small and only involved with obstructive sleep apnea hypopnea syndrome and cellular immune function, very little study of the humoral immune. To this end, we pause to further explore the obstructive sleep apnea hypopnea syndrome and immune function relationship, including humoral and cell-mediated immunity, and further understanding of obstructive sleep apnea hypopnea syndrome and its impact on the immune function . Purpose explore obstructive sleep apnea hypopnea syndrome whether there are changes in immune function (including the humoral and cellular immunity). 2, further understanding of obstructive sleep apnea syndrome and its impact on immune function. 1 retrospective study during the period September 2008 - December Nanfang Hospital Sleep Medicine Center 207 hospitalized patients, 187 called obstructive sleep apnea hypopnea syndrome patients, 20 were healthy. All patients must be excluded typical history of congenital immune deficiency or low disease, chronic diseases affecting the immune function and immune rejection or affect immune function, history of drug use. 2, all patients were all night at least seven hours of sleep monitoring, according to the apnea-hypopnea index (AHI), leather lowest oxygen saturation (LSpO2) at night initially mild, severe OSAHS (see OSAHS severity classification), and finally divided into a control group, mild group (AHI 5-14 times / hour, LSpO285-89%) in the severe group (AHI ≥ 15 / h LSpO2 lt; 84%) three groups. 3, all patients with a history of a unified standard program records include: In addition to recording personal sleep habits, occupation, alcohol and tobacco-loving daytime mental status, history of cardiovascular and cerebrovascular disease, focusing on recorded age, neck circumference (NC), height, weight, and to calculate body mass index (BMI), apnea-hypopnea index (AHI) and night the percutaneous lowest oxygen saturation (LSpO2). 4, obstructive sleep apnea syndrome diagnostic criteria: based on history, signs and PSG monitoring results. Clinically typical sleep at night snoring and breathing irregular, excessive daytime sleepiness (ESS score gt; 9 points), prompted by PSG monitoring nightly 7h sleep apnea and hypopnea repeated episodes more than 30 times, or AHI greater than or equal to 5 times / h. Obstructive sleep apnea hypopnea syndrome disease indexing: according AHI and nocturnal LSpO2, the obstructive sleep apnea hypopnea syndrome is divided into mild, moderate and severe, as the main criteria which the AHI, the night LSpO2 as reference . Obstructive sleep apnea syndrome disease indexing: mild AHI5-14 times / hour 85-90% LSpO2; moderate AHI 15-30 / hour LSpO2 80-84%; severe AHI gt; 30 times / hour , LSpO2 lt; 80%. 6, apnea is defined as oronasal flow stops for 10 seconds or more during sleep; hypopnea defined as respiratory airflow during sleep intensity (amplitude) compared to baseline levels reduced by 50% or more and accompanied by arterial oxygen saturation (Sa02) The more basic levels ≥ 3%, and continued for more than 10 seconds. 7, the end of polysomnography (PSG), the next morning, all patients samples were taken from the forearm superficial venous blood for determination of humoral and cellular immune. Humoral immunity, including C4, C3, IgM, IgA, IgG, CH50, application scattering turbidimetric method; cellular immunity, including CD3, CD3 CD4, CD3 CD8, NK, detected by flow cytometry. Humoral immune detection, 207, 102 detection of cell-mediated immunity due to economic reasons. 9, all data is entered into the computer, using the statistical software SPSS13.0 version pooled analysis. Experimental data using mean ± standard differential expressed; groups of measurement data comparison using One-Way ANOVA, homogeneity of variance with LSD test do pairwise comparisons; approximate F-test of the Welch method for unequal variances, and using Dunnett's T3 test done two two; correlation analysis using the Pearson correlation coefficient. P lt; 0.05 as the difference in the standard of statistical significance. Results of 1,207 patients were enrolled in this study were male and 190 (91.8%) and 17 women (8.2%); average age of 44.6 ± 11.7 years, mean BM128.21 ± 5.00kg/m2, average neck circumference 40.59 ± 3.74cm; average AHI37.47 ± 27.40 / h, average LSpO2 75.80 ± 11.90%. 2, the homogeneity of variance test, Levene test age, NC, BMI variance Qi (P = 0.46, P = 0.47 and P = 0.20), AHI, LSpO2 variance arrhythmia (P lt; 0.01 and P lt; 0.01); analysis of variance overall among the three groups age difference was not statistically significant (F = 0.169, P = 0.844), suggesting that grouping balanced; among the three groups the NC, BMI difference was statistically significant (F = 8.268, P lt; 0.01 and F = 29.706 , P lt; 0.01), need to do further multiple comparisons; overall among the three groups AHI LSpO2 with Welch method approximate F-test, the difference was statistically significant (F = 342.305, P lt; 0.01 and F = 119.852, P lt; 0.01), the need to do further multiple comparisons. NC, BMI using LSD test pairwise comparisons: NC severe OSAHS group and the control group and mild OSHAS group difference of statistical significance (P lt; 0.01 and P lt; 0.01), the control group with mild OSHAS group difference was not statistically significant (P gt; 0.05); BMI severe OSAHS group and the control group and mild OSHAS group difference of statistical significance (P = 0.001 and P = 0.004) and the control group with mild OSHAS group the difference was not statistically significant (P gt; 0.05); AHI LSpO2 do pairwise comparisons using Dunnett's T3 test: AHI difference in of in severe OSHAS group with the control group and mild OSHAS group with statistical significance (P lt; 0.01 and P lt; 0.01), the control group with mild OSHAS group difference was statistically significant (P lt; 0.01); LSpO2 in moderate-to-severe the OSHAS group and the control group and mild OSHAS group difference was statistically significant (P lt ; 0.01 and P lt; 0.01), the control group with mild OSHAS group difference was statistically significant (P lt; 0.01). 207 3, all of the humoral immune detection, control group 20, mild OSAHS group 32 people, in severe OSAHS group 155; cells immunized 102 people (for economic reasons), in which the control group (n = 20), mild OSAHS group of 25 moderate-to-severe the OSAHS group of 57 people, humoral immunity: Levene test C4, C3, IgM, IgG, of CH50 variance Qi (P = 0.95, P = 0.22, P = 0.18, P = 0.83 and P = 0.46), IgA variance arrhythmia (P = 0.04); analysis of variance overall among the three groups of C4, IgG and CH50 compare the difference was not statistically significant (F = 0.120, P = 0.887, F = 0.589, P = 0.556 and F = 1.294, P = 0.276), without further to do multiple comparisons; C3, IgM three groups the difference was statistically significant (F = 7.307, P = 0.001 and F = 4.523, P = 0.012), need to be further to do multiple comparisons; overall among the three groups IgA Welch method with approximate F test, the difference was not statistically significant (F = 1.177, P = 0.318), without further multiple comparisons. C3, IgM using the LSD test pairwise comparisons: C3 between the severe group and mild group and control group difference was statistically significant (P = 0.001 and P = 0.042) and the control group with the mild the OSHAS group comparison difference was not statistically significant (P gt; 0.05); IgM difference was statistically significant (P = 0.013 and P = 0.003) in the control group and the mild group and severe group, mild group and severe group no statistical difference significance (P gt; 0.05). 5 cellular immunity: homogeneity of variance test, Levene test CD3, CD3, CD3 CD4 CD8 homogeneity of variance (P = 0.71, P = 0.41, P = 0.06), NK cell heterogeneity of variance (P lt; 0.01); analysis of variance overall among the three groups of CD3, CD3 CD4, CD3 CD8 difference was not statistically significant (F = 2.329, P = 0.103, F = 1.153, P = 0.320 and F = 1.580, P = 0.211), without further multiple comparisons; overall need further multiple comparisons between the three groups of NK cells with approximate F test Welch method, the difference was statistically significant (F = 10.838, P lt; 0.01). NK cells using Dunnett's T3 test done pairwise comparisons: control group and mild the OSHAS group and in severe OSHAS group, the difference was statistically significant (P = 0.038 and P = 0.001), the OSHAS group of the the mild the OSHAS group with moderate to severe difference was statistically significant (P = 0.025). 6, OSAHS severity of AHI LSpO2 and C3, IgM, NK cell correlation: AHI and C3 correlation coefficient r = 0.403, P lt; 0.01, the correlation between the two was statistically significant, positive correlation; LSpO2 C3 correlation coefficient r = -0.364, P lt; 0.01, the correlation between the two was statistically significant and negative correlation; AHI and IgM correlation coefficient r = -0.107, P = 0.124 and correlation between the two was not statistically significant; LSpO2 and IgM coefficient r = 0.154, P = 0.027, the relationship between the two was statistically significant, weak positive correlation; AHI and NK cell correlation coefficient r = -0.296, P = 0.003, the relationship between the two was statistically significant, weak negative correlation; LSpO2 NK cell correlation coefficient r = 0.117, P = 0.076, both no statistically significant correlation. Conclusion 1, obstructive sleep apnea hypopnea syndrome patients and healthy subjects, humoral immune C3 levels increased IgM levels. 2, obstructive sleep apnea hypopnea syndrome patients and healthy individuals, NK cells in the cellular immune decline. Behalf of Suspension of obstructive sleep apnea hypopnea syndrome severity indicators: C3 AHI correlated statistically significant and positive correlation; the C3 and LSpO2 correlation was statistically significant, negative correlation. IgM levels with LSpO2 correlation was statistically significant, weak positive correlation (r absolute value of 0.154), while the correlation with AHI was not statistically significant. NK cells with AHI relationship was statistically significant, weak negative correlation (r absolute value of 0.297), with LSpO2 no statistically significant correlation. 4, obstructive sleep apnea hypopnea syndrome is a low-grade systemic chronic inflammatory response, obstructive sleep apnea hypopnea syndrome patients with changes in immune function, there may be a decline in immune function. The incidence of obstructive sleep apnea hypopnea syndrome due to a decline in IgM and NK cells, the body's immune defenses may exist, immune surveillance and immune steady decline, may cause a range of diseases, such as infections, tumors, etc. increased.
|