The Expression Of MMP-9 In Subtypes Of OSAHS Was Observed Based On Cluster Analysis

Objective:1.By including different variables of OSAHS patients,cluster analysis was conducted to explore the clinical characteristics among various OSAHS subtypes.2.The differences of MMP-9 expression and related serological indexes of subtypes under different clustering results were analyzed.Method:1.A total of 150 patients with OSAHS who received PSG monitoring due to snoring in the Department of Respiratory and critical Care Medicine of our hospital fromSeptember 2019 to October 2022 were collected according to the inclusion and exclusion criteria.Basic information of patients was collected:Age,sex,BMI,neck circumference,waist circumference,smoking history,family history of snoring,smoking index,clinical symptom score,ESS score,Berlin questionnaire,clinical symptoms,comorbidities and polysomnia parameters were included in cluster analysis variables.A total of 36 types（16continuous variables and 20 classified variables）were studied through principalcomponent analysis and two-step clustering method in cluster analysis to study the characteristics of OSAHS subtypes.2.Serological indexes of the patients were tested,including CRP,WBC,NEU,LYM,MONO,RBC,HB,PLT,NLR,PLR,TG,TC,HDL-C,LDL-C,D-D,FIB,FBG,UA,and to explore the differences and characteristics of serological indicators among subtypes.Using a random number table method,the serum of 90patients was randomly selected and the expression level of MMP-9 was measured by enzyme linked immunosorbent assay（ELISA）to analyze its characteristics.Results:1.Among the 1.150 patients,108（72%）were males and 42（28%）were females,aged19-79 years（50.53±14.20 years）.Through principal component analysis,16 continuous variables were dimensionally reduced and eigenvalues>1 were selected to obtain 6principal components.The cumulative variance contribution rate was 77.654%.Principal component 1 included LSa O₂,oxygen reduction index,AHI and MSa O₂.Principal component 2 included BMI,waist circumference and neck circumference;Principal component 3 includes snore index and total number of snore;Principal component 4included clinical symptom score,ESS score and smoking index.Principal component 5included age and number of complications.Principal component 6 included maximum duration of hypopnea and maximum duration of apnea.2.The 36 variables were selected through the two-step clustering method of clustering analysis and the Bayesian information criterion to select the best clustering results.The research objects were divided into 78 cases（52%）of subtype 1 and 72 cases（48%）of subtype 2.Characteristics of subtype 1:mainly female,gradeⅡobesity（BMI>30kg/m²）,large waist circumference,ESS score indicating excessive sleepiness,high proportion of snoring history in the family,AHI and ODI are mainly severe,more serious clinical symptoms,more likely to be complicated with cardiovascular and cerebrovascular diseases,especially hypertension.Characteristics of subtype 2:mainly male,gradeⅠobesity（28<BMI<30kg/m²）,smaller waist circumference than type 1,mild lethargy indicated by ESS,higher smoking index than type 1,lighter clinical symptoms than type1,more likely to be complicated with lung diseases,especially COPD.3.Serological indexes,in terms of routine blood,the subtype 1 CRP,WBC,NEU,MONO,NLR,RBC,HB expression were higher than subtype 2（P<0.05）,while LYM,PLT,PLR without statistical significance（P>0.05）;In terms of blood lipid,the expression of TG and TC of subtype 1 was higher,and the expression of HDL-C was lower（P<0.05）,while the expression of LDL-C was not statistically different（P>0.05）.In terms of blood coagulation,fasting blood glucose and uric acid,the FIB expression of subtype 1 was higher than that of subtype 2（P<0.05）,while the expressions of FBG,D-D and UA were not statistically different（P>0.05）.4.Enzyme-linked immunosorbent assay（ELISA）was used to determine the level of MMP-9 in 90 patients with OSAHS.The expression of MMP-9 in subtype 1 was higher than that in subtype 2（P<0.05）.Moreover,the expression of MMP-9 in cardiovascular and cerebrovascular diseases was moderately higher than that in other complications（lung disease,metabolic disease,chronic kidney disease）（P<0.05）.5.Spearman rank correlation analysis found that:AHI,ODI and maximum duration of apnea were positively correlated with serum MMP-9（correlation coefficients were0.278,0.314,0.307,P<0.05）,while MSa O₂ and LSa O₂ were negatively correlated with serum MMP-9（correlation coefficients were-0.250 and-0.349,P<0.05）.Conclusion:1.Through cluster analysis,patients with OSAHS were divided into different subtypes,fully reflecting the characteristics of each subtype.In this study,OSAHS was divided into subtype 1（more severe symptoms are easily associated with cardiovascular and cerebrovascular diseases）and subtype 2（symptoms are more easily associated with pulmonary diseases）.2.The clinical symptoms of subtype 1 were more severe,and the expression of serum inflammatory indicators was higher,indicating more severe disease.3.The expression level of MMP-9 is higher in subtype 1,and it is also higher in complicated cardiovascular and cerebrovascular diseases than other complications.MMP-9 can be used as an inflammatory indicator to evaluate the severity of OSAHS and predict the risk of concurrent cardiovascular diseases.