急性呼吸窘迫综合征机械通气进展黄茂急性呼吸窘迫综合征（a.ppt

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1、2021/9/231Effect of CPAP treatment on hypoadiponectinemia in male patients with obstructive sleep apnea syndrome Zhang Xilong,Yin Kaisheng Tha First Affiliated Hospital of Nanjing Medical University,Nanjing,China2021/9/232 Research BackgroundResearch Background Adiponectin,secreted by adipocytes,has

2、 been found recently to be associated with diabetes,obesity and some cardiovascular diseases.Recent research suggested that obstructive sleep apnea syndrome(OSAS)might be independently associated with hypoadiponectinemia,which was linked to some complications of OSAS,such as hypertension,diabetes,et

3、c.2021/9/233ObjectiveObjectiveTo investigate the effect of continuous positive airway pressure(CPAP)treatment on serum diponectine levels in male OSAS patients.2021/9/234 METHODS2021/9/235Diagnosis of OSASDiagnosis of OSASA Compumedic polysomnographer was used to measure and record overnight polysom

4、nography(PSG)parameters.The mininal criteria for diagnosis of SAS is apnea hypopnea index(AHI)5.The event was considered obstructive when chest and abdominal respiratory movements existed during apnea.2021/9/236SubjectsSubjects 23 adult male patients with moderate or severe OSAS Age:41.411.8 yrs(38

5、64 yrs)BMI:24.72.122021/9/237The exclusion criteriaThe exclusion criteria:type 2 diabetes or FBG 7.0mg/L BMI 28 cardiovascular diseases other chronic respiratory diseases 2021/9/238Test of serum adiponectin Three ml of venous blood was drawn at 7:00am following 12 hours overnight fasting.Serum adipo

6、nectin level was measured by radioimmunoassay.The agent kit for adiponectin testing was providedby LINCO Research Inc,USA.2021/9/239 Their blood samples were collected and mean arterial pressure(MAP,diastolic Bp+1/3 pulse pressure)was measured at 6:00 A.M.before CPAP treatment on day 3,day 7,day 14

7、of CPAP treatment2021/9/2310 RESULT2021/9/2311 Comparison of serum adiponectin levels,AHI and Comparison of serum adiponectin levels,AHI and MAP before and after CPAP treatment(x MAP before and after CPAP treatment(xs s)(n=23)(n=23)-AHI MAP AHI MAP adipolectinadipolectin (mmHg)(mg/L)(mmHg)(mg/L)-bef

8、ore CPAP 28.2before CPAP 28.25.8 101.2 101.28.1 3.95 3.950.210.21day 3 of CPAP 2.2day 3 of CPAP 2.20.6*98.898.87.6 4.01 4.010.27 0.27 day 7 of CPAP 2.3day 7 of CPAP 2.30.8*96.7 96.78.2 4.04 4.040.320.32day 14 of CPAP 1.9day 14 of CPAP 1.90.6*90.5 90.56.7*4.46 4.460.460.46*-*:P 0.05 vs before CPAP tr

9、eatment;*:P0.01 vs before CPAP treatment MAP:mean arterial pressure=diastolic Bp+1/3 pulse pressure2021/9/23122021/9/2313 P 0.01 P 0.012021/9/2314 DISCUSSION 2021/9/2315Different serum adiponectin levels based on different AHI in OSAS patients P 0.05 P 0.01 P 0.052021/9/2316Multiple biological funct

10、ions of adiponectin-anti-inflammation,anti-atherosclerosis,increase in sensitivity to insulin,decrease in insulin resistance and so on.2021/9/2317Reasons causing lower serum adiponectin levels in OSAS a)OSAS SaO2 and arousals sympathetic nervous system activity (beta adrenergic receptor agonist can

11、inhibit the expression of adiponectin gene,decreased adiponectin secretion).Delporte ML,et al.Biochem J 2002;367:677.b)OSAS interlukin-6(IL-6)adiponectin secretion and expression Yokoe T,et al.Circulation,2003,107:1129.c)OSAS tumor necrosis facor-(TNF-)adiponectin secretion and expression Hatipoglu

12、U,et al.Respiration 2003;70:6652021/9/2318Common explanation for pathogenesis of OSAS-associated hypertension:1)increase in sympathetic nerve system caused by recurrent hypoxia and arousals2)increased level of blood vasoconstrictors -catecholamine,renin-angiotension-adolesterone,endothelin Problem:C

13、PAP treatment can decrease the MAP as well as the above circulating vasoconstrictors,but usually they do not change simultaneously2021/9/2319b2021/9/2320 P 0.012021/9/2321 CONCLUSION 2021/9/2322 1.OSAS should be an independent risk factor for hypoadiponectinemia,which might be gradually reversed by CPAP treatment.2.Hypoadiponectinemia might be related to OSAS-associated hypertension.2021/9/23232021/9/2324