急性呼吸窘迫综合征机械通气进展黄茂急性呼吸窘迫综合征（a

EffectofCPAPtreatmentonhypoadiponectinemiainmalepatientswithobstructivesleepapneasyndromeZhangXilong,YinKaishengThaFirstAffiliatedHospitalofNanjingMedicalUniversity,Nanjing,ChinaResearchBackgroundAdiponectin,secretedbyadipocytes,hasbeenfoundrecentlytobeassociatedwithdiabetes,obesityandsomecardiovasculardiseases.Recentresearchsuggestedthatobstructivesleepapneasyndrome(OSAS)mightbeindependentlyassociatedwithhypoadiponectinemia,whichwaslinkedtosomecomplicationsofOSAS,suchashypertension,diabetes,etc.ObjectiveToinvestigatetheeffectofcontinuouspositiveairwaypressure(CPAP)treatmentonserumdiponectinelevelsinmaleOSASpatients.METHODSDiagnosisofOSASACompumedicpolysomnographerwasusedtomeasureandrecordovernightpolysomnography(PSG)parameters.ThemininalcriteriafordiagnosisofSASisapneahypopneaindex(AHI)≥5.Theeventwasconsideredobstructivewhenchestandabdominalrespiratorymovementsexistedduringapnea.Subjects23adultmalepatientswithmoderateorsevereOSASAge:41.4±11.8yrs(38~64yrs)BMI:24.7±2.12Theexclusioncriteria:type2diabetesorFBG7.0mg/LBMI28cardiovasculardiseasesotherchronicrespiratorydiseasesTestofserumadiponectinThreemlofvenousbloodwasdrawnat7:00amfollowing12hours’overnightfasting.Serumadiponectinlevelwasmeasuredbyradioimmunoassay.TheagentkitforadiponectintestingwasprovidedbyLINCOResearchInc,USA.Theirbloodsampleswerecollectedandmeanarterialpressure(MAP,diastolicBp+1/3pulsepressure)wasmeasuredat6:00A.M.beforeCPAPtreatmentonday3,day7,day14ofCPAPtreatmentRESULTComparisonofserumadiponectinlevels,AHIandMAPbeforeandafterCPAPtreatment(x±s)(n=23)---------------------------------------------------AHIMAPadipolectin(mmHg)(mg/L)---------------------------------------------------beforeCPAP28.2±5.8101.2±8.13.95±0.21day3ofCPAP2.2±0.6**98.8±7.64.01±0.27day7ofCPAP2.3±0.8**96.7±8.24.04±0.32day14ofCPAP1.9±0.6**90.5±6.7**4.46±0.46**------------------------------------------------------------------------*:P0.05vsbeforeCPAPtreatment;**:P0.01vsbeforeCPAPtreatmentMAP:meanarterialpressure=diastolicBp+1/3pulsepressure＊＊P0.0123232323N=ChangesofMAPbeforeandafterCPAPtreatmentday14ofCPAPday7ofCPAPday3ofCPAPbeforeCPAPMeanarterialpressure(mmHg)11010090805247＊＊P0.01DISCUSSIONDifferentserumadiponectinlevelsbasedondifferentAHIinOSASpatients＊P0.05＊＊P0.01＊P0.05Multiplebiologicalfunctionsofadiponectin-----------------------------------------------------------anti-inflammation,anti-atherosclerosis,increaseinsensitivitytoinsulin,decreaseininsulinresistanceandsoon.ReasonscausinglowerserumadiponectinlevelsinOSASa)OSASSaO2↓andarousalssympatheticnervoussystemactivity↑(betaadrenergicreceptoragonistcaninhibittheexpressionofadiponectingene,decreasedadiponectinsecretion).DelporteML,etal.BiochemJ2002;367:677.b)OSASinterlukin-6(IL-6)↑adiponectinsecretionandexpression↓YokoeT,etal.Circulation,2003,107:1129.c)OSAStumornecrosisfacor-α(TNF-α)↑adiponectinsecretionandexpression↓HatipogluU,etal.Respiration2003;70:665CommonexplanationforpathogenesisofOSAS-associatedhypertension:1)increaseinsympatheticnervesystemcausedbyrecurrenthypoxiaandarousals2)increasedlevelofbloodvasoconstrictors----catecholamine,renin-angiotension-adolesterone,endothelin…Problem:CPAPtreatmentcandecreasetheMAPaswellastheabovecirculatingvasoconstrictors,butusuallytheydonotchangesimultaneouslyb23232323N=ChangesofMAPbeforeandafterCPAPtreatmentday14ofCPAPday7ofCPAPday3ofCPAPbeforeCPAPMeanarterialpressure(mmHg)11010090805247＊＊P0.01CONCLUSION1.OSASshouldbeanindependentriskfactorforhypoadiponectinemia,whichmightbegraduallyreversedbyCPAPtreatment.2.HypoadiponectinemiamightberelatedtoOSAS-associatedhypertension.