阻塞性睡眠呼吸暂停低通气综合征儿童中血清维生素D检测的意义

doi:10.6040/j.issn.1673-3770.0.2016.507

摘要/Abstract

摘要： 目的探讨血清维生素D检测对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)儿童的临床意义。方法选择因打鼾症状于山东大学齐鲁医院耳鼻咽喉科治疗的儿童69例作为实验组,70例健康儿童作为对照组,化学发光免疫测定法检测139例儿童的外周血清25(OH)D水平。有打鼾症状儿童69例根据睡眠监测结果将其分为OSAHS组(47例),单纯鼾症组(22例),69例儿童采取空腹血测定血清甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平,并采用Conners 父母症状问卷从品行问题、学习问题、心身障碍、焦虑、冲动-多动、多动指数方面评估两组儿童行为认知异常。结果 (1) 对照组与单纯鼾症组、OSAHS组研究对象血清25(OH)D水平分别为(25.38±10.87)、(22.00±7.84)、(17.92±6.32)ng/mL,差异有统计学意义(F=9.458, P<0.001);OSAHS组25(OH)D水平低于对照组,差异有统计学意义(P<0.001),单纯鼾症组25(OH)D水平与对照组及OSAHS组差异均无统计学意义(P值均>0.05);(2) 肥胖(-)儿童中,OSA(+)儿童25(OH)D水平明显低于OSA(-)儿童,差异有统计学意义(P=0.001)。OSA(+)儿童中,肥胖(+)儿童与肥胖(-)儿童25(OH)D水平差异无统计学意义(P=0.566); (3) OSAHS组25(OH)D水平与焦虑呈正相关(r=0.337, P=0.020),与最低血氧饱和度(LSaO₂)、低通气指数(AHI)、品行问题、学习问题、心身障碍、冲动-多动、多动指数、TG、TC、HDL-C、LDL-C无明显相关性(r值均<0.5, P值均>0.05)。结论 25(OH)D在OSAHS儿童体内降低,对进一步了解OSAHS儿童的病理生理改变有一定的临床意义。

关键词: 睡眠呼吸暂停,阻塞性, 儿童, 维生素D

Abstract: Objective To investigate the clinical significance of detecting serum vitamin D level in children with obstructive sleep apnea-hypopnea syndrome(OSAHS). Methods During June and Octorber 2016, 69 children with snoring were divided into the OSAHS group(n=47)and primary snoring(PS)group(n=22)according to the apnea-hypopnea index(AHI), and 70 healthy children without snoring served as controls. Venous blood was drawn from each child to measure the serum level of 25(OH)D, triglycerides(TG), total cholesterol(TC), high-density lipoprotein cholesterol(HDL-C)and low-density lipoprotein cholesterol(LDL-C). Childrens behaviors were assessed with Conners Parent Symptom Questionnaire(PSQ). Results (1) The mean serum 25(OH)D level of the control, PS and OSAHS groups were 25.38±10.87 ng/mL, 22.00±7.84 ng/mL, and 17.92±6.32 ng/mL(F=9.458, P<0.001). There was significant difference between the OSAHS group and the control group(P<0.001), but no statistical difference between the PS group and the control group(P>0.05). (2) Non-obese children with OSA had significantly lower 25(OH)D level than non-obese children without OSA(P=0.001). There were no significant difference between obese children with OSA and non-obese children with OSA(P=0.566). (3) The 25(OH)D level of the OSAHS group showed positive correlation with anxiety(r=0.337, P=0.020), but no significant correlation with AHI, PSQ, TG, TC, HDL-C and LDL-C(r<0.5, P>0.05). Conclusion The level of serum 25(OH)D is significantly decreased in children with OSAHS, which may help to explore the pathophysiological changes of OSAHS.

Key words: Sleep apnea, obstructive, Vitamin D, Children

中图分类号:

R766.7

刘婷,王岩,李延忠. 阻塞性睡眠呼吸暂停低通气综合征儿童中血清维生素D检测的意义[J]. 山东大学耳鼻喉眼学报, 2017, 31(1): 21-26.

参考文献

[1] OBrien LM, Mervis CB, Holbrook CR, et al. Neurobehavioral correlates of sleep-disordered breathing in children[J]. J Sleep Res, 2004, 13(2):165-172.
[2] Lagishetty V, Liu NQ, Hewison M. Vitamin D metabolism and innate immunity[J]. Mol Cell Endocrinol, 2011, 347(1-2):97-105.
[3] Aydin S, Aslan I, Yildiz I, et al. Vitamin D levels in children with recurrent tonsillitis[J]. Int J Pediatr Otorhinolaryngol, 2011, 75(3):364-367.
[4] Reid D, Morton R, Salkeld L, et al. Vitamin D and tonsil disease-preliminary observations[J]. Int J Pediatr Otorhinolaryngol, 2011, 75(2):261-264.
[5] Pinto JM, Schneider J, Perez R, et al. Serum 25-hydroxyvitamin D levels are lower in urban African American subjects with chronic rhinosinusitis[J]. J Allergy Clin Immunol, 2008, 122(2):415-417.
[6] Mccarty MF, Thomas CA. PTH excess may promote weight gain by impeding catecholamine-induced lipolysis-implications for the impact of calcium, vitamin D, and alcohol on body weight[J]. Med Hypotheses, 2003, 61(5-6):535-542.
[7] Erden ES, Genc S, Motor S, et al. Investigation of serum bisphenol A, vitamin D, and parathyroid hormone levels in patients with obstructive sleep apnea syndrome[J]. Endocrine, 2014, 45(2):311-318.
[8] Sateia MJ. International classification of sleep disorders-third edition:highlights and modifications[J]. Chest, 2014, 146(5):1387-1394.
[9] 中华耳鼻咽喉头颈外科杂志编委会. 中华医学会耳鼻咽喉科学分会.儿童阻塞性睡眠呼吸暂停低通气综合征诊疗指南草案(乌鲁木齐)[J]. 中华耳鼻咽喉头颈外科杂志, 2007, 42(2):83-84.
[10] Hossein-Nezhad A, Holick MF. Vitamin D for health: a global perspective[J]. Mayo Clin Proc, 2013, 88(7):720-755.
[11] 沈晓明, 王卫平. 儿科学[M]. 7版. 北京: 人民卫生出版社, 2004:75-77.
[12] Jorde R, Grimnes G. Vitamin D and metabolic health with special reference to the effect of vitamin D on serum lipids[J]. Prog Lipid Res, 2011, 50(4):303-312.
[13] Hawes JE, Tesic D, Whitehouse AJ, et al. Maternal vitamin D deficiency alters fetal brain development in the BALB/c mouse[J]. Behav Brain Res, 2015, 286:192-200.
[14] Pan P, Jin DH, Chatterjee-Chakraborty M, et al. The effects of vitamin D(3)during pregnancy and lactation on offspring physiology and behavior in sprague-dawley rats[J]. Dev Psychobiol, 2014, 56(1):12-22.
[15] Yin L, Grandi N, Raum E, et al. Meta-analysis: longitudinal studies of serum vitamin D and colorectal cancer risk[J]. Aliment Pharmacol Ther, 2009, 30(2):113-125.
[16] Salekzamani S, Neyestani TR, Alavi-Majd H, et al. Is vitamin D status a determining factor for metabolic syndrome? A case-control study[J]. Diabetes Metab Syndr Obes, 2011, 4:205-212.
[17] Gominak SC, Stumpf WE. The world epidemic of sleep disorders is linked to vitamin D deficiency[J]. Med Hypotheses, 2012, 79(2):132-135.
[18] Cutolo M, Paolino S, Sulli A, et al. Vitamin D, steroid hormones, and autoimmunity[J]. Ann N Y Acad Sci, 2014, 1317:39-46.
[19] 牟林琳. 综述维生素D与免疫功能相关的临床疾病研究[J]. 中国中医药咨讯, 2011, 3(4):37.
[20] Wang LF, Lee CH, Chien CY, et al. Serum 25-hydroxyvitamin D levels are lower in chronic rhinosinusitis with nasal polyposis and are correlated with disease severity in Taiwanese patients[J]. Am J Rhinol Allergy, 2013, 27(6):e162-e165.
[21] Abuzeid WM, Akbar NA, Zacharek MA. Vitamin D and chronic rhinitis[J]. Curr Opin Allergy Clin Immunol, 2012, 12(1):13-17.
[22] Camargo CJ, Ganmaa D, Frazier AL, et al. Randomized trial of vitamin D supplementation and risk of acute respiratory infection in Mongolia[J]. Pediatrics, 2012, 130(3):e561-e567.
[23] Nunn JD, Katz DR, Barker S, et al. Regulation of human tonsillar T-cell proliferation by the active metabolite of vitamin D3[J]. Immunology, 1986, 59(4):479-484.
[24] Wood RJ. Vitamin D and adipogenesis: new molecular insights[J]. Nutr Rev, 2008, 66(1):40-46.
[25] Tauman R, Lavie L, Greenfeld M, et al. Oxidative stress in children with obstructive sleep apnea syndrome[J]. J Clin Sleep Med, 2014, 10(6):677-681.
[26] Penna G, Roncari A, Amuchastegui S, et al. Expression of the inhibitory receptor ILT3 on dendritic cells is dispensable for induction of CD4+Foxp3+ regulatory T cells by 1,25-dihydroxyvitamin D3[J]. Blood, 2005, 106(10):3490-3497.
[27] Kamen DL, Tangpricha V. Vitamin D and molecular actions on the immune system: modulation of innate and autoimmunity[J]. J Mol Med(Berl), 2010, 88(5):441-450.
[28] Kheirandish-Gozal L, Bhattacharjee R, Kim J, et al. Endothelial progenitor cells and vascular dysfunction in children with obstructive sleep apnea[J]. Am J Respir Crit Care Med, 2010, 182(1):92-97.
[29] Suzuki Y, Ichiyama T, Ohsaki A, et al. Anti-inflammatory effect of 1alpha, 25-dihydroxyvitamin D(3)in human coronary arterial endothelial cells: Implication for the treatment of Kawasaki disease[J]. J Steroid Biochem Mol Biol, 2009, 113(1-2):134-138.
[30] Pan P, Jin DH, Chatterjee-Chakraborty M, et al. The effects of vitamin D(3)during pregnancy and lactation on offspring physiology and behavior in sprague-dawley rats[J]. Dev Psychobiol, 2014, 56(1):12-22.
[31] Kerley CP, Hutchinson K, Bolger K, et al. Serum Vitamin D Is Significantly Inversely Associated with Disease Severity in Caucasian Adults with Obstructive Sleep Apnea Syndrome[J]. Sleep, 2016, 39(2):293-300.
[32] Kheirandish-Gozal L, Peris E, Gozal D. Vitamin D levels and obstructive sleep apnoea in children[J]. Sleep Med, 2014, 15(4):459-463.
[33] Barcelo A, Esquinas C, Pierola J, et al. Vitamin D status and parathyroid hormone levels in patients with obstructive sleep apnea[J]. Respiration, 2013, 86(4):295-301.
[34] Esteitie R, Naclerio RM, Baroody FM. Vitamin D levels in children undergoing adenotonsillectomies[J]. Int J Pediatr Otorhinolaryngol, 2010, 74(9):1075-1077.
[35] Jorde R, Grimnes G. Vitamin D and metabolic health with special reference to the effect of vitamin D on serum lipids[J]. Prog Lipid Res, 2011, 50(4):303-312.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed