山东大学耳鼻喉眼学报 ›› 2016, Vol. 30 ›› Issue (5): 33-37.doi: 10.6040/j.issn.1673-3770.0.2016.347
许梅杰,苏梅,薛荣,张希龙
XU Meijie, SU Mei, XUE Rong, ZHANG Xilong
摘要: 目的 探讨研究中性粒细胞/淋巴细胞比值(NLR)与阻塞性睡眠呼吸暂停综合征(OSAS)程度的关系。 方法 将158例按照睡眠期呼吸暂停低通气指数(AHI)情况分为4个组,分别为正常对照组(n=39)、轻度OSAS组(n=38)、中度OSAS组(n=41)和重度OSAS组(n=40),此外对重度OSAS组中的31例实施持续气道正压(CPAP)治疗3个月,对该31例进行CPAP治疗前后对比。比较的血细胞参数包括白细胞、中性粒细胞、淋巴细胞、中性粒细胞/淋巴细胞比值(NLR)。 结果 NLR的组间比较显示重度OSAS组(3.29±1.19)显著高于正常对照组(1.71±0.69)、轻度OSAS组(1.70±0.71),中度OSAS组较正常对照组和轻度OSAS组亦明显增高(均为P<0.05),而正常对照组与轻度OSAS组间及中度OSAS组与重度OSAS组间差异无统计学意义(P>0.05)。重度OSAS患者CPAP治疗前后对比结果显示治疗后NLR(1.98±0.81)较治疗前NLR(3.28±0.62)显著降低(P<0.05)。此外4个组中NLR与睡眠期AHI是呈正相关的(r=0.758, P=0.034),同时最低氧饱和度与AHI呈负相关(r=-0.179, P=0.012)。 结论 NLR可随着OSAS程度的加重而增高,因而可能作为一新的指标用来辅助评估OSAS患者体内炎症反应的严重程度。
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[1] Fawale M B, Ibigbami O, Ismail I, et al. Risk of obstructive sleep apnea, excessive daytime sleepiness and depressive symptoms in a Nigerian elderly population[J]. Sleep Sci, 2016, 9(2):106-111. [2] 陈梅晞, 陈思, 周燕, 等. 脂肪因子与阻塞性睡眠呼吸暂停综合征[J]. 临床肺科杂志, 2012, 17(4):696-698. CHEN Meixi, CHEN Si, ZHOU Yan, et al. Association between chemerin and obstructive sleep apnea syndrome[J]. J Clin Pulmonary Med, 2012, 17(4):696-698. [3] Kushida C A, Littner M R, Morgenthaler T, et al. Practice parameters for the indications for polysomnography and related procedures: an update for 2005[J]. Sleep, 2005, 28(4):499-521. [4] Martínez-García M A, Campos-Rodríguez F, Catalán-Serra P, et al. Cardiovascular mortality in obstructive sleep apnea in the elderly: role of long-term continuous positive airway pressure treatment: a prospective observational study[J]. Am J Respir Crit Care Med, 2012, 186(9):909-916. [5] Kusumanto Y H, Dam W A, Hospers G A, et al. Platelets and granulocytes, in particular the neutrophils, form important compartments for circulating vascular endothelial growth factor[J]. Angiogenesis, 2003, 6(4):283-287. [6] Guthrie G J, Charles K A, Roxburgh C S, et al. The systemic inflammation-based neutrophil-lymphocyte ratio: experience in patients with cancer[J]. Crit Rev Oncol Hematol, 2013, 88(1):218-230. [7] Tamhane U U, Aneja S, Montgomery D, et al. Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome[J]. Am J Cardiol, 2008, 102(6):653-657. [8] Hori T, Sugita Y, Koga E, et al. Proposed supplements and amendments to ‘A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects’, the Rechtschaffen & Kales(1968)standard[J]. Psychiatry Clin Neurosci, 2001, 55(3):305-310. [9] Gould G A, Whyte K F, Rhind G B, et al. The sleep hypopnea syndrome[J]. Am Rev Respir Dis, 1988, 137(4):895-898. [10] Baltzis D, Bakker J P, Patel S R, et al. Obstructive sleep apnea and vascular diseases[J]. Compr Physiol, 2016, 6(3):1519. [11] 计明, 李从荣. 阻塞性睡眠呼吸暂停综合征患者血清IL-6、TNF-α测定的临床意义[J]. 微循环学杂志, 2008, 18(4):43-45. JI Ming, LI Congrong. Clinical significance of serum levels of IL-6 and TNF-α in patients with obstructive sleep apnea syndrome[J]. Chin J Microcirculation, 2008, 18(4):43-45. [12] 周克明, 骆秦, 邵亮,等. 夜间间歇性低氧与高血压患者系统性炎症水平的相关性研究[J]. 新疆医科大学学报, 2016, 39(2):196-199. ZHOU Keming, LUO Qin, SHAO Liang, et al. Relationship between nocturnal chronic intermittent hypoxia and systemic inflammation in hypertensive patients[J]. J Xinjiang Med Univ, 2016, 39(2):196-199. [13] Mehra R, Redline S. Sleep apnea: a proinflammatory disorder that coaggregates with obesity[J]. J Allergy Clin Immunol, 2008, 121(5):1096-1102. [14] Nadeem R, Molnar J, Madbouly E M, et al. Serum inflammatory markers in obstructive sleep apnea: a meta-analysis[J]. J Clin Sleep Med, 2013, 9(10):1003-1012. [15] Guven S F, Turkkani M H, Ciftci B, et al. The relationship between high-sensitivity C-reactive protein levels and the severity of obstructive sleep apnea[J]. Sleep Breath, 2012, 16(1):217-221. [16] Poyton R O, Ball K A, Castello P R. Mitochondrial generation of free radicals and hypoxic signaling[J]. Trends Endocrinol Metab, 2009, 20(7):332-340. [17] Dai R, Phillips R A, Ahmed S A. Despite inhibition of nuclear localization of NF-kappa B p65, c-Rel, and RelB, 17-beta estradiol up-regulates NF-kappa B signaling in mouse splenocytes: the potential role of Bcl-3[J]. J Immunol, 2007, 179(3):1776-1783. [18] Dyugovskaya L, Hirsh M, Ginsburg H. Phenotypic profile and functional characterization of rat lymph node-derived gammadelta T cells: implication in the immune response to cytomegalovirus[J]. Immunology, 2003, 108(2):129-136. [19] Yokoe T, Minoguchi K, Matsuo H, et al. Elevated levels of C-reactive protein and interleukin-6 in patients with obstructive sleep apnea syndrome are decreased by nasal continuous positive airway pressure[J]. Circulation, 2003, 107(8):1129-1134. [20] Turkmen K, Guney I, Yerlikaya F H, et al. The relationship between neutrophil-to-lymphocyte ratio and inflammation in end-stage renal disease patients[J]. Ren Fail, 2012, 34(2):155-159. [21] Dyugovskaya L, Polyakov A, Lavie P, et al. Delayed neutrophil apoptosis in patients with sleep apnea[J]. Am J Respir Crit Care Med, 2008, 177(5):544-554. [22] Akpek M, Kaya M G, Lam Y Y, et al. Relation of neutrophil/lymphocyte ratio to coronary flow to in-hospital major adverse cardiac events in patients with ST-elevated myocardial infarction undergoing primary coronary intervention[J]. Am J Cardiol, 2012, 110(5):621-627. [23] Li M X, Liu X M, Zhang X F, et al. Prognostic role of neutrophil-to-lymphocyte ratio in colorectal cancer: a systematic review and meta-analysis[J]. Int J Cancer, 2014, 134(10):2403-2413. [24] Duffy B K, Gurm H S, Rajagopal V, et al. Usefulness of an elevated neutrophil to lymphocyte ratio in predicting long-term mortality after percutaneous coronary intervention[J]. Am J Cardiol, 2006, 97(7):993-996. [25] Gibson P H, Croal B L, Cuthbertson B H, et al. Preoperative neutrophil-lymphocyte ratio and outcome from coronary artery bypass grafting[J]. Am Heart J, 2007, 154(5):995-1002. [26] Arruda-Olson A M, Reeder G S, Bell M R, et al. Neutrophilia predicts death and heart failure after myocardial infarction: a community-based study[J]. Circ Cardiovasc Qual Outcomes, 2009, 2(6):656-662. [27] Rudiger A, Burckhardt O A, Harpes P, et al. The relative lymphocyte count on hospital admission is a risk factor for long-termmortality in patients with acute heart failure[J]. Am J Emerg Med, 2006, 24(4):451-454. [28] 沈小琴, 郭敏. 高敏C反应蛋白、中性粒细胞/淋巴细胞比值与心力衰竭的研究进展[J]. 心血管康复医学杂志, 2015, 12(6):676-678. SHENG Xiaoqin, GUO Min. Research progress on the relationship among high sensitive C reactive protein, neutrophil-lymphocyte ratio and heart failure[J]. Chin J Cardiovascular Rehabilitation Med, 2015, 12(6):676-678. [29] Uygur F, Tanriverdi H, Aktop Z, et al. The neutrophil-to-lymphocyte ratio in patients with obstructive sleep apnoea syndrome and its relationship with cardiovascular disease[J]. Heart Lung, 2016, 45(2):121-125. |
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