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目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者下丘脑-垂体-肾上腺轴和生长激素轴激素水平的变化及相互调节。方法对 OSAHS 患者(OSAHS 组)和单纯肥胖者(对照组)进行多导睡眠监测,应用酶联免疫吸附测定(ELISA)和放射免疫法测定睡前和睡后血浆促肾上腺皮质素释放激素(CRH)、促肾上腺皮质素(ACTH)、皮质醇、促生长素释放激素(GHRH)和生长激素(GH),分析其间的变化关系。结果与对照组比较,OSAHS 组患者 CRH、皮质醇明显升高[对照组睡前、睡后 CRH 分别为(0.67±0.42)、(2.27±1.10)mmol/L,OSAHS 组分别为(1.66±0.34)、(4.96±0.98)mmol/L;对照组睡前、睡后皮质醇分别为(68.94±20.13)、(146.05±30.48)μg/L,OSAHS 组分别为(152.93±136.15)、(445.53±123.09)μg/L;P 均<0.01];GHRH 降低[对照组睡前、睡后 GHRH 分别为(1.99±0.34)、(1.58±0.15)mmol/L,OSAHS 组分别为(1.42±0.07)、(1.01±0.05)mmol/L;P 均<0.05],而 GH 未表现明显差异(P>0.05);睡眠前后 CRH、GHRH 变化值之比(ΔCRH/ΔGHRH,285.02±143.32)也显著高于对照组(71.15±15.37,P<0.01);ΔCRH/ΔGHRH 与平均觉醒时间呈正相关(r=0.882),与平均血氧饱和度呈负相关(r=-0.696),平均血氧饱和度与平均觉醒时间呈负相关(r=-0.729)。结论 OSAHS 患者下丘脑-垂体-肾上腺轴和生长激素轴水平异常,反馈调节紊乱,并与睡眠觉醒和夜间低氧有关。
Objective To investigate the changes and mutual regulation of hypothalamus-pituitary-adrenal axis and growth hormone axis hormone in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods Polysomnography was performed on OSAHS patients (OSAHS group) and simple obesity patients (control group). Serum levels of corticotropin-releasing hormone (CRH) before going to sleep and after sleep were measured by enzyme-linked immunosorbent assay (ELISA) and radioimmunoassay ), Corticotropin (ACTH), cortisol, ghrelin (GHRH), and growth hormone (GH) were analyzed. Results Compared with the control group, CRH and cortisol were significantly increased in OSAHS group (CRH, (0.67 ± 0.42) and (2.27 ± 1.10) mmol / L before going to bed and after sleep, OSAHS group were (1.66 ± 0.34, ), (4.96 ± 0.98) mmol / L respectively. The levels of cortisol before and after bedtime in control group were (68.94 ± 20.13) and (146.05 ± 30.48) μg / L respectively, and those in OSAHS group were (152.93 ± 136.15 and 445.53 ± (1.99 ± 0.34) and (1.58 ± 0.15) mmol / L respectively in the control group and (1.42 ± 0.07) and (1.42 ± 0.07) mmol / L in the OSAHS group, respectively (1.01 ± 0.05) mmol / L, P <0.05], while GH did not show significant difference (P> 0.05). The ratio of changes of CRH and GHRH before and after sleep (ΔCRH / ΔGHRH, 285.02 ± 143.32) (71.15 ± 15.37, P <0.01). There was a positive correlation between ΔCRH / ΔGHRH and mean awakening time (r = 0.882), negatively correlated with mean oxygen saturation (r = -0.696), mean oxygen saturation Time was negatively correlated (r = -0.729). Conclusion The abnormal hypothalamic-pituitary-adrenal axis and growth hormone axis in OSAHS patients are disturbed by feedback regulation, and are related to sleep arousal and nocturnal hypoxia.