目的 探讨炎症因子和肺功能与阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syn-drome,OSAHS)病情程度相关性,为临床治疗提供参考.方法 选择浙江医院2018年3月—2020年3月收治的OSAHS患者179例;另选择同期健康体检者80例作为对照组.采用酶联免疫吸附法测定白介素(IL)-6、IL-18和肿瘤坏死因子-α(TNF-α)水平;采用肺功能仪测定潮气量(VT)、最大肺活量(VCmax)、用力肺活量(FVC)和第1秒用力呼气容积(FEV1);采用匹兹堡睡眠质量指数(PSQI)评价睡眠质量.结果 血清IL-6、IL-18和TNF-α水平比较,轻中度组[(28.21±5.12)pg/mL、(22.35±4.12)ng/L 和(187.46±37.23)ng/L]和重度组[(45.17±6.71)pg/mL、(42.10±5.62)ng/L 和(297.42±30.19)ng/L]高于对照组[(11.82±3.27)pg/mL、(9.65±2.19)ng/L 和(108.91±25.26)ng/L],均P＜0.05.VT、VCmax、FVC和FEV1比较,轻中度组和重度组低于对照组(均P＜0.05).IL-6、IL-18和TNF-α与重度OSAHS呈线性正相关,而VT、VCmax、FVC和FEV1与重度OSAHS呈线性负相关.结论 OSAHS患者存在炎症反应、肺功能下降,且与病情程度呈正相关.

Objective:To investigate the health-related quality of life (HRQOL) of patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) through a questionnaire.Methods:The study period was from January 2019 to August 2019. A cross-sectional study was used to evaluate the quality of life of all 200 subjects diagnosed with OSAHS (OSAHS group) and 50 healthy controls (healthy control group) in Zhejiang Hospital by means of 36 summary health surveys (SF-36). Spirometry was performed to assess lung function, and the chronic lung disease (CLD) severity index was used to assess the severity of symptoms, measured patients′ neck circumference, and analyzed correlations between variables and patients′ quality of life.Results:The average disease duration of the OSAHS patients was (2.8 ± 0.5) years, the average Epworth sleep scale (ESS) score was (8.9 ± 0.8) scores, the CLD index was (30.5 ± 2.2) scores, and the average neck circumference was (41.5 ± 3.8) cm, respectively. Compared with healthy control group, the OSAHS patients had significant damage in all fields, and the difference was statistically significant ( P < 0.05). Lung function indicators including the percentage of forced expiratory volume in the first second occupied estimated value (FEV 1%), the ratio of forced expiratory volume in the first second and forced vital capacity (FEV 1/FVC) showed negative correlations with scores of SF-36 in all fields ( P < 0.05). The age, disease duration, ESS score, neck circumference and body mass index (BMI) were associated with poor HRQOL( P < 0.05). Patients′ living standard was significantly correlated with HRQOL ( χ2 = 71.25, P < 0.01). Conclusions:The HRQOL of patients with OSAHS is generally low. Poor lung function, increased disease duration, smoking, increased neck circumference and BMI, and increased daytime sleepiness can adversely affect HRQOL.

阻塞性睡眠呼吸暂停(obstructive sleep apnea, OSA)是由于患者睡眠时上气道完全或部分阻塞,导致呼吸暂停和睡眠结构紊乱、引起夜间反复低氧血症和高碳酸血症.根据其临床症状,归属于中医"鼾症"范畴.隋代巢元方《诸病源候论·鼾眠候》首次将鼾症作为一个独立病证,认为痰湿内生是其重要的发病因素.