山东大学耳鼻喉眼学报 ›› 2019, Vol. 33 ›› Issue (4): 131-137.doi: 10.6040/j.issn.1673-3770.0.2018.446

• 荟萃分析 • 上一篇    下一篇

CPAP治疗对阻塞性睡眠呼吸暂停综合征患者血清炎症标志物影响的Meta分析

陈淳1,丁健1,谢晋2   

  1. 1.上海交通大学附属第一人民医院耳鼻咽喉头颈外科, 上海 200080;
    2.上海交通大学医学院附属新华医院耳鼻咽喉头颈外科, 上海 200093
  • 出版日期:2019-07-20 发布日期:2019-07-22

Effects of continuous positive airway pressure therapy on inflammatory markers in obstructive sleep apnea syndrome: a meta-analysis

CHEN Chun1, DING Jian1, XIE Jin2   

  1. Department of Otolaryngology & Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University, Shanghai 200080, China
  • Online:2019-07-20 Published:2019-07-22

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摘要： 目的 阻塞性睡眠呼吸暂停低通气综合征(OSAS)可致全身炎症反应,是心血管疾病的一个独立危险因素,持续气道正压通气治疗(CPAP)已被证明可改善血清炎症标志物水平。研究通过对历年文献进行系统的荟萃分析,评估CPAP治疗对OSAS患者炎症标志物水平的影响。 方法 在PubMed、EMBASE和Cochrane图书馆检索系统检索英文文献,均以成人为研究对象,每项研究至少包含≥1个炎症标志物治疗前后的水平变化。OSAS定义为睡眠呼吸暂停低通气指数(AHI)≥5/h,用标准均数差(SMD)评估CPAP治疗是否降低炎症标志物水平。 结果 共筛选出1 128项研究报道,其中27项纳入分析。C反应蛋白(CRP)有17篇文献共895例患者;肿瘤坏死因子-α(TNF-α)有10篇文献共290例患者纳入研究。统计发现CPAP治疗前后OSAS患者血清CRP水平差异具有统计学意义(Z=4.55,P<0.00001,SMD 0.86,95% CI:0.49-1.23),CPAP治疗前后TNF-α水平变化差异无统计学意义(Z=1.92,P=0.05,SMD 1.08,95% CI:0.02-2.18)。 结论 长期CPAP治疗可降低OSAS患者血清CRP水平,而血清TNF-α水平无明显下降。CPAP治疗能够有效改善全身炎症反应,预防心血管疾病的进展。

关键词: 睡眠呼吸暂停, 持续正压通气, 炎症标志物, C反应蛋白, 肿瘤坏死因子-α

Abstract: Objective In recent years, the morbidity associated with obstructive sleep apnea syndrome(OSAS)has been increasing. It could be associated with inflammatory reactions and is a risk factor for coronary artery disease(CAD). Current evidence suggests that continuous positive airway pressure(CPAP)changes the levels of inflammatory markers. We analyzed the data from published studies using a systematic meta-analysis. Methods Study eligibility criteria included full-text English studies from PubMed, Embase, and Cochrane libraries, addressing the values of at least one of the inflammatory markers before and after CPAP treatment. We used the definition of OSA as an apnea-hypopnea index(AHI)of ≥5/h and reported values as means with standard deviations. Statistical results showed that the serum C-reactive protein(CRP)levels of OSAS patients before and after CPAP treatment were significantly different(Z= 4.55; P<0.000 01; SMD=0.86; 95%CI=0.49-1.23). There were no significant differences in tumor necrosis factor-α(TNFα)levels before and after CPAP treatment(Z=1.92; P=0.05; SMD=1.08; 95%CI=0.02-2.18). Results A total of 17 studies involving 895 OSA patients were included in the meta-analysis of CRP, and 10 studies involving 290 OSA patients on TNF-α were included. Conclusion CPAP therapy partially suppresses systemic inflammation in OSA patients, and substantial differences are present among the various inflammatory markers. CPAP has been proposed to be linked with the pathogenesis of systemic inflammation to prevent cardiovascular diseases.

Key words: Sleep apnea, Continuous Positive Airway Pressure, Inflammatory markers, C-reactive protein, Tumor necrosis factor-α

中图分类号: 

  • R766.7
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