中国呼吸与危重监护杂志

中国呼吸与危重监护杂志

慢性心力衰竭患者中枢性睡眠呼吸暂停与血清瘦素水平相关性

查看全文

目的 探讨慢性心力衰竭(CHF)患者中枢性睡眠呼吸暂停(CSA)与血清瘦素(LEP)水平的相关性。 方法 采用前瞻性方法,纳入 2015 年 12 月至 2017 年 4 月入住武汉大学人民医院心血管内科及呼吸科并进行多导睡眠监测的 CHF 患者,检测血清 LEP 及 N 末端脑钠肽前体(NT-proBNP)水平,分析其与 CSA 的相关性。根据左室射血分数(LVEF)将患者分为三组,再根据是否存在 CSA 分为 CSA 组与无睡眠呼吸障碍(SDB)组。 结果 71 例 CHF 患者中,31 例 LVEF≥45%,19 例在 35%~45%,21 例≤35%;32 例存在 CSA,39 例无 SDB。存在 CSA 各 CHF 组的 LEP 水平明显低于无 SDB 组,NT-proBNP 水平也更高。Logistic 回归分析显示,CSA 与对数转换后的 LEP(lnLEP)相关(三组 OR 分别为 0.047、0.030、0.021,P 均<0.05)。在 LVEF≤35% 组,高水平 NT-proBNP 者发生 CSA 事件风险性高(OR=5.942,P=0.045),发生率高达 71.4%,明显高于其他组,但在对年龄、性别、体重指数等因素进行校正后,这种相关性不再存在(OR=6.432,P=0.105)。与无 SDB 者相比,存在 CSA 严重心功能不全患者的 LEP 更低,在对年龄、性别、体重指数等因素进行校正后,这种相关性仍存在(OR=0.013,P=0.002)。同时,线性相关分析还显示,对数转换后的 NT-proBNP 与 lnLEP 呈负相关(R=–0.751,P<0.001),对年龄、性别及体重指数进行校正后,此相关性依然存在(R=–0.607,P=0.004)。 结论 CHF 患者 LEP 水平下降及 NT-proBNP 升高可能预示 CSA 的发生。

Objective To assess the correlation between central sleep apnea (CSA) and serum leptin (LEP) levels in patients with chronic heart failure. Methods The level of serum LEP and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured by forward-looking method in patients with chronic heart failure who underwent polysomnography during hospitalization from December 2015 to April 2017 in Department of Cardiology and Respiratory Medicine, Renmin Hospital of Wuhan University. And its correlation with CSA was analyzed. Patients were divided into three groups according to the left ventricular ejection fraction (LVEF), and then according to the presence or absence of CSA into CSA group and without SDB group. Results Of the 71 patients with heart failure, 31 had LVEF≥45%, 19 were between 35% and 45% and 21 were≤35% ; 32 of whom were CSA and 39 had no SDB. The lEP concentrations in the LVEF subgroup of CSA groups were significantly lower than those in the control group without SDB, with significantly higher levels of NT-proBNP. Logistic regression showed that CSA was associated with logarithmic LEP (lnLEP) (OR=0.047, 0.030, 0.021, P<0.05). In severe heart failure (LVEF≤35%) group, high NT-proBNP was the risk of CSA (OR=5.942, P=0.045) and the incidence of CSA was as high as 71.4%, which was significantly higher than other groups. However, after adjustment for confounding factors such as age, sex and body mass index (BMI), the correlation no longer existed (OR=6.432, P=0.105). Moreover, CSA with severe cardiac insufficiency had lower LEP than those without SDB. After adjustment for confounding factors such as age, sex and BMI, CSA and lnLEP remained significantly correlated (OR=0.013, P=0.002). Meanwhile, linear correlation analysis also showed that NT-proBNP was negatively correlated with lnLEP (R=–0.751, P<0.001). After adjusting for age, sex, and BMI, this relationship still existed (R=–0.607, P=0.004). Conclusion Decreased levels of leptin and elevated NT-proBNP in patients with chronic heart failure may indicate the presence of CSA.

关键词: 中枢性睡眠呼吸暂停; 瘦素; 慢性心力衰竭

Key words: Central sleep apnea; Leptin; Chronic heart failure

引用本文: 李慧敏, 熊梦清, 胡克, 董明林, 胡卫华. 慢性心力衰竭患者中枢性睡眠呼吸暂停与血清瘦素水平相关性. 中国呼吸与危重监护杂志, 2018, 17(5): 499-503. doi: 10.7507/1671-6205.201712006 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Oldenburg O, Wellmann B, Buchholz A, et al. Nocturnal hypoxaemia is associated with increased mortality in stable heart failure patients. Eur Heart J, 2016, 37(21): 1695-1703.
2. Dickstein K, Cohen-Solal A, Filippatos G, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur J Heart Fail, 2008, 10(10): 933-989.
3. 何权瀛. 如何认识由慢性心力衰竭所引起的中枢性睡眠呼吸暂停. 中华结核和呼吸杂志, 2017, 40(2): 144-146.
4. de Haro MC, Figueiredo VN, de Faria AP, et al. High-circulating leptin levels are associated with increased blood pressure in uncontrolled resistant hypertension. J Hum Hypertens, 2013, 27(4): 225-230.
5. Hilzendeger AM, da Costa Goncalves AC, Plehm R, et al. Autonomic dysregulation in ob/ob mice is improved by inhibition of angiotensin-converting enzyme. J Mol Med (Berl), 2010, 88(4): 383-390.
6. 张延斌, 彭勇, 杨煜, 等. 慢性心力衰竭患者血浆瘦素水平的变化. 中国病理生理杂志, 2007, 23(11): 2270-2271.
7. 翟英慧. 男性慢性心力衰竭患者血清瘦素水平的变化. 中华老年多器官疾病杂志, 2006, 5(1): 51.
8. Cundrle I Jr, Somers VK, Singh P, et al. Low leptin concentration may identify heart failure patients with central sleep apnea. J Sleep Res, 2018, 27(2): 240-243.
9. Cundrle I Jr, Somers VK, Singh P, et al. Leptin deficiency promotes central sleep apnea in patients with heart failure. Chest, 2014, 145(1): 72-78.
10. 中华医学会心血管病分会, 中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南 2014. 中华心血管病杂志, 2014, 42(2): 98-122.
11. Berry RB, Budhiraja R, Gottlieb DJ, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med, 2012, 8(5): 597-619.
12. Sateia MJ. International classification of sleep disorders-third edition: highlights and modifications. Chest, 2014, 146(5): 1387-1394.
13. Malli F, Papaioannou AI, Gourgoulianis KI, et al. The role of leptin in the respiratory system: an overview. Respir Res, 2010, 11(1): 152.
14. 贺群, 李明晖. 阻塞性睡眠呼吸暂停低通气综合征程度与血压变异性和血清瘦素相关性研究. 中华全科医学, 2017, 15(2): 258-260.
15. Cusin I, Sainsbury A, Doyle P, et al. The ob gene and insulin. A relationship leading to clues to the understanding of obesity. Diabetes, 1995, 44(12): 1467-1470.
16. 顾卫琼, 洪洁, 张翼飞, 等. 肥胖人群中血清瘦素、游离脂肪酸和脂联素水平的相互关系. 中华内分泌代谢杂志, 2003, 19(3): 169-172.
17. 张珺辉. 睡眠呼吸暂停/低通气综合征的危害性及健康指导. 中国全科医学, 2002, 5(3): 185-187.
18. Tkacova R, Hall M, Liu P, et al. Left ventricular volume in patients with heart failure and cheyne-stokes respiration during sleep. Am J Respir Crit Care Med, 1997, 156(5): 1549-1555.
19. Andreas S. Central sleep apnea and chronic heart failure. Sleep, 2000, 15(23): S220-223.
20. Xie A, Skatrud JB, Puleo DS, et al. Apnea-hypopnea threshold for CO2 in patients with congestive heart failure. Am J Respir Crit Care Med, 2002, 165(9): 1245-1250.
21. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur J Heart Failure, 2016, 18(8): 891-975.
22. Yuan K, Yu J, Shah A, et al. Leptin reduces plasma ANP level via nitric oxide-dependent mechanism. Am J Physiol Regul Integr Comp Physiol, 2010, 298(4): R1007-R1016.