摘要目的 观察子痫前期合并阻塞性睡眠呼吸暂停(OSA)患者的血清IL-18水平,通过持续气道正压通气(CPAP)观察IL-18的改变.方法 纳入2008年8月至2010年8月常州市妇幼保健医院行多导睡眠监测(PSG)及常规孕期体检的妊娠妇女,孕期24～40周,年龄23～40岁,其中AHI＜5次/h的健康妊娠妇女18名(健康对照组),AHI＜5次/h的子痫前期患者18例(单纯子痫组),AHI≥5次/h的子痫前期患者16例(子痫合并OSA组),其中6例AHI≥15次/h,行持续气道正压通气(CPAP)治疗1周(治疗组).采用ELISA法测定血清IL-18水平并比较各组及治疗前后的差异.结果 健康对照组、单纯子痫组及子痫合并OSA组血清IL-18水平为(261±95)、( 382±121)和(601±89) ng/L,各组间差异均有统计学意义(均P＜0.01).治疗组患者CPAP治疗后,AHI、收缩压及血清IL-18水平均降低,最低脉氧饱和度明显升高(均P＜0.01),舒张压明显下降(P＞0.05).结论 子痫前期合并OSA患者IL-18水平较高,提示OSA可能诱导和加重机体更强的炎症反应而增加子痫前期的发病率,经CPAP治疗有效.

abstractsObjective To investigate the role of IL-18 in the obstructive sleep apnea syndrome (OSAS)-induced preeclampsia (PE),by comparison of the changes of serum IL-18 levels among different groups as well as before and after continuous positive airway pressure (CPAP) treatment in pregnant women with both OSAS and PE.Methods In control group there were 18 normal pregnant women with apnea hypopnea index (AHI) ＜5.In simple PE group 18 pregnant PE patients with an AHI ＜5 were recruited.In PE plus OSAS group 16 PE patients with coexisting OSAS were collected.CPAP treatment was performed for I week in 6 patients with AHI ＞ 15 from PE plus OSAS group.Serum IL-18 levels were measured with ELISA.Result There was a significant difference in serum IL-18 levels among control group [ (261 ±95)ng/L],simple PE group [ ( 382 ± 121 ) ng/L],and PE plus OSAS group [ (601 ± 89 ) ng/L,all P ＜0.001 ].Following CPAP treatment,there was a significant decrease in AHI,systolic blood pressures,and serum IL-18 levels,but a significant increase in minimal SpO2 ( P ＜ 0.01 ).Conclusion Our study demonstrated that serum IL-18 levels in PE patients with OSAS were significantly elevated,which suggested that OSAS might increase the incidence of PE by enhancing inflammatory response,while CPAP treatment could effectively improve the pathological process.