Toll-like Receptor 4 Expression In Serum And Sputum Of Patients With Obstructive Sleep Apnea

Objective:By detecting the expression levels of Toll like receptor 4(TLR4)in peripheral blood and sputum of patients with Obstructive sleep apnea OSA of different severity and the normal control group,the relationship between TLR4 and OSA severity was analyzed.At the same time analysis of peripheral blood and sputum expression level of TLR4 and Apnea hypoventilation index(Apnea hypopnea index AHI),the Lowest oxygen saturation(Lowest oxygen saturation,LSaO2),average blood oxygen saturation(Mean oxygen saturation,MSaO2),the Longest suffocation time(the Longest Apnea time,LAT),for the condition of OSA severity assessment and treatment to provide new targets.Methods:Choose between April 2018 and November 2019 to see a doctor at the second affiliated hospital of kunming medical university respiratory patients with OSA risk factors or related symptoms in clinic,according to guide more sleep test Polysomnography(PSG)as a result,finally choose 8 cases of normal control group,the first diagnosis of 37 patients with OSA,including 13 cases of mild group,medium group of 12 cases,12 cases of severe group,collect blood samples.Sputum from normal control group was collected in 17 cases,and sputum from OSA patients in 16 cases.General data of subjects and PSG monitoring indexes were recorded.Enzyme-linked Immunosorbent Assay(ELISA)was used to detect TLR4 expression levels in each group,and correlation analysis was performed according to AHI,LAT,LSaO2,MSaO2 and other factorsResults:1.Basic data analysis for each group(1)there was no significant difference in age and BMI between serum groups.The differences of AHI,LSao2,MSao2 and LAT between serum groups were statistically significant.(2)there were no significant differences in age and BMI between the sputum groups,while there were significant differences in AHI,LSaO2,MSaO2 and LAT between the groups.2.TLR4 level analysis in each group(1)in the serum OS A group,TLR4 in the OS A group was significantly higher than that in the non-osa group(mild(P=0.02<0.05),moderate(P=0.002<0.05)and severe(P=0.000<0.05).There was no significant difference in TLR4 between the mild group and the moderate group(P=0.09>0.05).The severe group was significantly higher than the mild group(P=0.002<0.05).There was no significant difference in TLR4 between the moderate group and the severe group(P=0.2>0.05).(2)the level of TLR4 in sputum of the OSA group was significantly higher than that of the non-osa group,with a significant difference(P<0.001).3.Correlation analysis of TLR4 levels among each group(1)serum TLR4 level was positively correlated with AHI(r=0.40 p<0.05)and LAT(r=0.41 p<0.05).TLR4 expression in serum was negatively correlated with LSaO2(r=-0.31 p<0.05)and MSaO2(r=-0.34 p<0.05).(2)TLR4 expression in sputum was positively correlated with AHI(r=0.40 p<0.05)and LAT(r=0.50 p<0.003),which was statistically significant.There was a negative correlation between LSaO2(r=-0.41 p<0.05)and MSaO2(r=-0.49 p<0.01),which was statistically significant.4.ROC curve analysis of TLR4(1)the disease group(OSA and OSA)as state variables,in TLR4(serum)expression level of ROC curve drawing test variables,the area under the curve(area under the curve AUC)was 89.4%,P=0.001<0.05,with an estimated index,sensitivity+1)place for the best value,the maximum of the optimal value of 2.56 ng/mL,the sensitivity was 83.8%,87.5%,when the TLR4 acuity 2.56 ng/mL,considering patients may exist for OSA.(2)the disease group(non-osa and OSA)was used as the state variable,and the ROC curve was drawn with the expression level of TLR4(sputum)as the test variable.The AUC was 78.1%,P=0.006<0.05,and the maximum value of the youdon index(sensitivity+specificity-1)was used as the optimal threshold value,and the optimal value was 4.375ng/mL.The OSA sensitivity was 68.8%,and the specificity was 94.1%.When TLR4≥4.375ng/mL,the presence of OSA was considered.Conclusions:1.Compared with the normal group,serum TLR4 levels in patients with mild,moderate and severe OSA were significantly increased and increased with the severity of the disease.2.The sputum TLR4 level of OSA patients was significantly higher than that of the normal control group.3.TLR4 levels in blood and sputum were significantly correlated with AHI,LSaO2,MSaO2 and LAT.4.TLR4 levels in blood and sputum were positively correlated with AHI and LAT,and negatively correlated with LSaO2 and MSaO2.TLR4 can be used as an indicator to evaluate the severity of OSA.The higher the expression level of TLR4,the more severe the severity of OSA.5.When TLR4(serum)is used to distinguish non-osa from OSA,when TLR4≥2.25ng/mL,patients are likely to have OSA,with a sensitivity of 83.8%and specificity of 87.5%.When TLR4(sputum)was used to distinguish non-osa from OSA,when TLR4≥4.375ng/mL,patients were likely to have OSA,with a sensitivity of 68.8%and specificity of 94.1%,indicating a low sensitivity.Therefore,serum TLR4 can be used as one of the indicators to predict disease risk.