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目的探讨睡眠质量对冠心病患者血清炎性因子及血管内皮功能的影响,为改善冠心病患者的预后效果提供依据。方法选择2016年6-12月在河南省南阳医学高等专科学校第一附属医院住院的195例冠心病患者为研究对象,使用匹兹堡睡眠质量指数表(PSQI)评估冠心病患者睡眠质量,按照分类标准将其分为低睡眠质量组(83例)和正常睡眠质量组(112例),测定患者血清超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)水平,采用高分辨率的彩色多普勒超声仪检测冠心病患者肱动脉血流介导的扩张反应(FMD)进而判断血管内皮功能。用SPSS 20.0统计软件对数据进行t检验、χ~2检验及多重线性回归分析。结果低睡眠质量组冠心病患者血清IL-6、TNF-α水平较正常睡眠质量组明显升高,并且FMD低于正常睡眠质量组,差异均有统计学意义(P<0.05)。多重线性回归分析显示,调整年龄、性别、体质指数(BMI)、收缩压(SBP)、舒张压(DBP)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖(FPG)后,睡眠质量得分与IL-6和TNF-α呈独立正相关(β值分别为0.294、1.702,P<0.05,P<0.01),与FMD呈负相关(β=-0.078,P<0.05),与hs-CRP无明显相关性(β=0.164,P>0.05)。进一步调整炎性因子(IL-6,TNF-α)后,睡眠质量得分与FMD无明显相关性(β=-0.054,P>0.05)。结论应积极改善冠心病患者的睡眠质量,降低炎症反应及减少对血管内皮功能的损害,延缓疾病进展。
Objective To investigate the effects of sleep quality on serum inflammatory factors and endothelial function in patients with coronary heart disease (CHD) and provide basis for improving the prognosis of patients with coronary heart disease. Methods A total of 195 coronary heart disease patients hospitalized in the First Affiliated Hospital of Nanyang Medical College from June 2016 to December 2016 were selected as the study subjects. Pittsburgh sleep quality index (PSQI) was used to assess the quality of sleep in patients with coronary heart disease. According to the classification criteria The patients were divided into low sleep quality group (n = 83) and normal sleep quality group (n = 112). Serum high sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α) and interleukin -6 (IL-6) levels were measured by flow cytometry. The brachial artery-mediated dilatation (FMD) in patients with coronary heart disease was detected by high-resolution color Doppler ultrasound. Data were analyzed by SPSS 20.0 software t test, χ ~ 2 test and multiple linear regression analysis. Results The serum levels of IL-6 and TNF-α in patients with low sleep quality were significantly higher than those in normal sleep quality group, and the FMD was lower than that of normal sleep quality group (P <0.05). Multiple linear regression analysis showed that adjusting for age, sex, BMI, SBP, DBP, TG, TC, LDL- C, HDL-C and FPG, there was a positive correlation between sleep quality score and IL-6 and TNF-α (β values were 0.294,1.702, P <0.05, P <0.01), but negatively correlated with FMD (β = -0.078, P <0.05), but no significant correlation with hs-CRP (β = 0.164, P> 0.05). After further adjustment of inflammatory factors (IL-6, TNF-α), there was no significant correlation between sleep quality score and FMD (β = -0.054, P> 0.05). Conclusions Should actively improve the quality of sleep in patients with coronary heart disease, reduce the inflammatory response and reduce the damage to vascular endothelial function, delay the disease progression.