摘要目的 观察OSAHS患者诱导痰中烟酰胺腺嘌呤二核苷酸磷酸(NADPH)氧化酶p22phox的水平,探讨OSAHS患者气道局部氧化应激与病情严重程度的关系.方法 对2007年9月至2008年6月华中科技大学附属同济医院呼吸科就诊并进行睡眠监测的30例OSAHS患者和23名健康体检者分别行痰诱导,睡前和晨起各1次.其中OSAHS组男27例,女3例,平均年龄(43±9)岁;健康对照组男21名,女2名,平均年龄(45±10)岁.痰细胞涂片并行细胞分类计数,以逆转录PCR法检测诱导痰细胞中NADPH氧化酶p22phox mRNA水平,以免疫细胞化学法检测诱导痰细胞中NADPH氧化酶p22phox蛋白的表达水平.结果 OSAHS组诱导痰细胞中巨噬细胞百分比为(34±10)%,低于对照组的(66±5)%;而中性粒细胞百分比为(65±10)%,高于对照组的(33±5)%,两组比较,差异均有统计学意义(t=15.051、14.359,P<0.05).诱导痰细胞中NADPH氧化酶p22phox阳性细胞主要为中性粒细胞和巨噬细胞.OSAHS组2次诱导痰细胞中NADPH氧化酶p22phox mRNA水平及中性粒细胞和巨噬细胞阳性率均明显高于对照组.OSAHS组晨起时NADPH氧化酶p22phoxmRNA的表达水平及中性粒细胞和巨噬细胞阳性率高于睡前,并与最低脉搏氧饱和度呈负相关,与呼吸暂停低通气指数呈正相关.结论 OSAHS患者存在气道局部NADPH氧化酶p22phox表达水平的变化,并与病情严重程度相关.

abstractsObjective The aim of the study was to observe the change of NADPH oxidase p22phox expression in the induced sputum cells for patients with obstructive sleep apnea hypopnea syndrome (OSAHS), and its relationship with the severity of OSAHS. Methods Thirty OSAHS patients and 23 healthy centrols were recruited in the study. Before sleep and in the next morning sputum induction was performed twice for each subject, cell numbers and differentials in induced sputum were counted. NADPH oxidase p22phox mRNA expression was measured in induced sputum cells by RT-PCR and the protein was measured by immunocytochemistry. Results The OSAHS group showed a significant higher percentage of neutrophils and a lower percentage of macrophages in the induced sputum compared to the control group (P < 0.05). Macrophages and neutrnphils represented the main cell types expressing NADPH oxidase p22phox in induced sputum cells by immunocytochemistry. In the control group, level of NADPH oxidase p22phox mRNA and percentages of NADPH oxidase p22phox positive neutrophils and macrophages in sputum samples collected both in the morning and before sleep was significantly lower than in OSAHS group(P <0.05). In OSAHS group, higher levels of NADPH oxidase p22phox mRNA and percentages of NADPH oxidase p22phox positive neutrophils and macrophages were found in the morning than at pre-sleep. A negative correlation was found between levels of NADPH oxidase p22phox mRNA and percentage of NADPH oxidase p22phox positive neutrophils and maerophages in the morning sputum were negatively associated with LspO_2, but positively associated with AHI. Conclusion These findings suggest that there are changes of NADPH oxidase p22phox expression in induced sputum cells of OSAHS patients,and these changes are related to the severity of OSAHS.