| Objective:Many of the Cerebrovascular disease (CVD) patients sufferfrom obstructive sleep apnea syndrome (OSAS),many patients with OSASacute cerebrovascular disease as a clinical diagnosis,and both of them have ahigh complication rate. Obesity,age,hypertension,alcohol use,diabetes,bloodviscosity increased so as both risk factors. Recent studies show that theinflammatory response mechanism plays an important role in the incidence ofcerebral infarction and pathophysiological mechanisms,so this exploreresearch provides an important basis for the prevention,diagnosis andtreatment of cerebrovascular disease. Another study also showed that OSAScan induce inflammatory response process and promote the generation ofinflammatory factors. Chronic inflammatory response not only promote theformation of atherosclerotic plaque but also cause plaque changing from stableto unstable.Therefore,OSAS and cerebrovascular disease may be a commonpathogenesis.OSAS plays a very important role in the development ofatherosclerosis,cerebrovascular,cardiovascular,diabetes and other diseases.Tumor necrosis factor-α (TNF-α) as an inflammatory factor,not only promotethe development of atherosclerosis but also increase frequency of patients withnocturnal awakenings,daytime sleepiness heavier. Matrix metallo proteinase-9(MMP-9) can be processed and modified other inflammatory factors.Itparticipates in the destruction of the body chronic intermittent hypoxia and thedamage of the blood-brain barrier in acute cerebrovascular disease. Toinvestigate the levels of TNF-α and MMP-9in moderate-severe OSAS withcerebrovascular disease in human peripheral blood and correlation with apneahypopnea index and Oxygen desaturation index.The changes of serumMMP-9,TNF-α in OSAS patients with cerebrovascular disease by nasal continuous positive airway pressure treatment is the new ideas for thesecondary prevention of cerebrovascular disease.Methods: Subjects: All cases are patients with CVD treated in Wardsand outpatient of the department of neurology which collected from February2011to December2012in Second Hospital of Hebei Medical University.They determine suffering from CVD which includ stroke and transientischemic events(the time of onset of stroke≥3months <1year;the time ofonset of a mild stroke and transient ischemic events≥7days).All of thesubjects were excluded from secondary infection,tumor,systemic autoimmunedisease,severe liver and kidney disease,diabetes; accept steroid hormonedrugs,immunosuppressive agents or other anti-inflammatory medications;recent major surgery and a history of trauma,tumors and autoimmune diseases.ApneaLinkTM was performed in these CVD patients to identify if they werecomplicated by OSAS. Among them,50cases of male and10cases offemale,age between39to78years old,average age (58.95±9.826) years ofage，moderate to severe OSAS with CVD group (AHI≥30or ODI≥12times/h) are29cases,including23males and6females,average age53.38±7.655years old,non-OSAS with CVD group (AHI <5or ODI <5times/h) are29cases,including22males and7females,average age58.76±6.561yearsold. Normal control group: over the same period to the examination center ofour hospital healthy people of normal physical examination,no significanthistory of snoring in20cases. Among them,15males and5femalepatients,average age55.70±7.561years.The healthy people withoutsignificant history of snoring for a normal physical examination in healthexamination center in the same period were chosen as control subjects.Among them,15males and5female patients,average age55.70±7.561years.3ml samples of peripheral venous blood were collected at the next morningafter ApneaLinkTM was performed. Samples were stored at80°C untilassayed. Double-antibody sandwich ELISA to detect levels of TNF-α andMMP-9. Professional statistical software SPSS16.0analysis of experimentaldata processing. The levels of TNF-α and MMP-9were detected by a double antibody sandwich ELISA. Experimental data was performed with theprofessional statistical software SPSS16.0.Results:1Between the moderate to severe OSAS with CVD group andnon-OSAS with CVD group and control group,gender (P=0.926,P>0.05),age(P=0.301,P>0.05) was not statistically different.2Body mass index (BMI) between the three groups,moderate to severeOSAS with CVD group and non-OSAS with CVD group,the control groupthere is a statistically significant difference (P <0.01),non-OSAS with CVDgroup and the control group does not exist significant difference (P>0.01).3MMP-9levels of moderate to severe OSAS with CVD group (719.37±59.08) ng/ml was significantly higher than the non-OSAS group (653.28±100.49) ng/ml,and the control group (501.96±67.023) ng/ml (P <0.01).MMP-9level of the non-OSAS group was significantly higher (P <0.01)thancontrol group. TNF-α levels of moderate to severe OSAS with CVD group(27.13±4.30) pg/ml and non-OSAS group (25.21±3.81) pg/ml,and thecontrol group (21.93±6.20) pg/ml,although a downward trend,but nosignificant difference (P>0.01). There was no significant difference (P>0.01)between the non-OSAS group and the control group.4nCPAP significantly decreased the levels of MMP-9(P＜0.05) in theCVD patients with moderate to severe OSAS.The levels of TNF-αhave adownward trend,but not statistically significant (P>0.05).5In the CVD patients with moderate to severe OSAS. The levels ofMMP-9,TNF-α and AHI (43.66±13.35) times/h,ODI (39.17±17.43) times/hhas a positive correlation (correlation coefficient of>0.1,P<0.05).Conclusion:1CVD patients have a pro-inflammatory state,while OSAS mayexacerbate the inflammatory response of brain disease,induce or aggravateCVD.2nCPAP significantly decreased the levels of MMP-9(P＜0.05)and AHIin the CVD patients with moderate to severe OSAS. 3The test serum MMP-9level on the prevention of recurrence and theprognosis of CVD has a certain value,while the test serum TNF-α levels havea smaller significance in prognosis and prevention of CVD recurrence.4The using of nCPAP may reduce the CVD reoccurrence ofCerebrovascular disease Patients Complicated with moderate to severe OSAS. |
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