稳定期COPD、OSAHS及重叠综合征患者间呼出气一氧化氮水平差异及nCPAP治疗的影响

Differences in levels of fractional exhaled nitric oxide among patients with COPD of stable period,OSAHS and overlap sydrome and the effects of nCPAP treatment on fractional exhaled nitric oxide

关键词:  呼出气一氧化氮  OSAHS  重叠综合征  nCPAP

Key words:  fractional exhaled nitric oxide  OSAHS  overlap syndrome  nCPAP

摘要:

目的　探讨稳定期慢性阻塞性肺疾病（COPD）、阻塞性睡眠呼吸暂停低通气综合征（OSAHS）及重叠综合征(OS)患者呼出气一氧化氮（FeNO）的水平差异，分析FeNO与多导睡眠指标的相关性及nCPAP治疗对FeNO的影响。方法　收集经多导睡眠监测（PSG）、肺功能检查确诊患者71例，分为稳定期COPD组28例、OSAHS组23例、OS组20例，并收集健康对照组25例。采用一氧化氮测定仪检测FeNO水平，分析比较各组FeNO的差异，对FeNO水平与睡眠监测指标进行直线相关分析。经nCPAP治疗2周，观察中重度OSAHS、OS组各18例FeNO水平的变化。结果　稳定期COPD、OSAHS、OS组患者FeNO水平均显著高于健康对照组（P<0.05）；OS组FeNO水平显著高于OSAHS组和稳定期COPD组（P<0.05）；FeNO与AHI、血氧饱和度＜90%的时间比率呈正相关，与夜间最低血氧饱和度呈负相关（P<0.05）；nCPAP治疗后中重度OSAHS组、OS组FeNO水平较治疗前均显著下降（P<0.01）。结论　FeNO水平增高可提示气道炎症水平较高，与病情严重程度相关，nCPAP治疗可减轻气道炎症。

Abstract:

Objective To explore the differences of fractional exhaled nitric oxide (FeNO) in patients with chronic obstuctive pulmonary disease (COPD) of stable phase, obstructive sleep apnea hypopnea syndrome (OSAHS) and overlap syndrome (OS) and to analyze the relationship between FeNO level and PSG indexes, and the effects of nCPAP treatment on FeNO. Methods Totally 71 patients, who were diagnosed by PSG and pulmonary function examination, were divided into the COPD group of stable phase (28 cases), OSAHS group (23 cases) and OS group (20 cases). healthy people (n=25) were enrolled in the study as control group. The level of FeNO and cognitive function were measured by nitric oxide measuring instrument. Difference of FeNO levels in each group was analyzed, linear correlation analysis was performed on the relationship between FeNO level and PSG indexes. The changes of FeNO levels in 18 moderate to severe OSAHS patients and 18 OS patients after 2 weeks of nCPAP therapy were recorded. Results The levels of FeNO were significantly higher in the COPD group of stable phase, OSAHS group and OS group than that in healthy control (P<0.05). The level of FeNO was significantly higher in OS group than those in COPD group of stable phase and OSAHS group (P<0.05). The level of FeNO was positively correlated with AHI and time ratio of SaO2 <90%, and negatively correlated with LSpO2 (P<0.05).FeNO levels in moderate to severe OSAHS and OS patients became lower after nCPAP therapy (P<0.01). Conclusion Higher levels of FeNO indicate higher airway inflammation, and relate to the severity of the disease. nCPAP therapy can reduce airway inflammatory reaction.