The Relevance Between The Pentraxin 3 Levels Of Patients With Obstructive Sleep Apnea And Hypopnea Syndrome And Acute Coronary Syndrome

Objective: Obstructive sleep apnea syndrome(OSAHS) and the morbidity and mortality of cardiovascular and cerebrovascular diseases are closely related, in particular the hypoxemia it leads to increase the incidence of acute cardiovascular events, but the mechanism is not fully understood. As the pathogenesis of both OSAHS and acute cardiovascular events have chronic inflammation involved, there are numerous researches on the relationship between OSAHS and acute coronary syndrome(ACS) at home and abroad in recent years,mainly related to the molecular level such as pentraxin 3(PTX3), high-sensitivity C-reactive protein(hs-CRP), lipids and other relevant indicators. Through compare the difference of the above target levels among the OSAHS with ACS group, ACS group and control group, investigate the clinical significance of serum PTX3 levels in OSAHS patients with ACS.Methods:Select the patients due to chest pain or chest tightness clinic at department of Cardiology and Respiratory Medicine in the Second Affiliated Hospital of Dalian Medical University, from June 2014 to November 2014, the coronary angiography examination or CT of them has no definite coronary artery stenosis,according to the results of poly-somnography( PSG), sleep apnea hypopnea index(AHI) <5/h were 19 cases included in the control group. Strict select the blood samples of 65 cases of ACS patients within eight hours after symptoms begin, and monitor the levels of cardiac markers within 72 h, select the highest value. Until in stable condition underwent PSG monitoring, AHI≥5 times / hour in 34 cases included in OSAHS with ACS group, AHI <5 times / hour were 31 cases included in the ACS group. By the enzyme-linked immune sorbent assays(ELISA) method determine the serum PTX3 level of subjects,and hs-CRP assay using immunoturbidimetry. For categorical variables between groups were compared using chi-square test; for the continuous variables use of K-S normality test at first,for normally distributed variables among groups were compared using analysis of variance, for non-normally distributed variables among groups Wilcoxon test was used; using Spearman rank correlation analysis does not meet the normal distribution of the correlation between variables; using Logistic regression analysis of risk factors for coronary heart disease. According to the constitute ACS diagnosis and severity of OSAHS subgroup respectively stratified analyzes the difference between the relevant indicators.Result:(1) The difference between the three groups of subjects in general and the accompanying circumstances were not statistically significant between(P> 0.05), the presence of comparable.(2) On the diagnosis structure of all the ACS patients, in ACS group ST-elevation myocardial infarction, non-ST-elevation myocardial infarction and unstable angina were 10 cases(32.3%), 11 cases(35.5%) and 10 cases(32.3 %); and in ACS with OSAHS group, the above date were 11 cases(32.4%), 11 cases(32.4%) and 12 cases(35.3%); the two groups showed no significant difference constitutes diagnosis(P> 0.05).(3) Three groups of subjects PSG test results, clinical and biochemical indicators, through the K-S normality test found AHI, nadirSpO2, PTX3, hs-CRP, CK-MB, CTNI, Glu are not normally distributed, so the rank sum test was used to compare between the two groups and found statistically significant(P <0.05),and compared with the control group, ACS with OSAHS group and the ACS group AHI, PTX3, CK-MB, CTNI, Glu was significantly higher(P <0.05), and the ACS with OSAHS group higher than in the ACS group(P <0.05); compared with the control group, ACS group, ACS with OSAHS group,the nadirSp O2 decreased significantly(P <0.001). the remaining variables TC, TG, HDL-C, LDL-C and TC / HDL-C five indicators in line with normal distribution, through the analysis of variance found that the above indicators of differences between the groups were not statistically significant(P> 0.05).(4) Using Logistic regression analysis of risk factors for ACS, ACS known risk factors AHI, nadirSp O2, PTX3, hs-CRP and HDL-C is a correlation between the risk of ACS statistically significant(P <0.05). Which AHI, PTX3, hs-CRP is positively correlated with the ACS, and nadirSpO2,HDL-C is negatively correlated with the ACS.(5) The correlation analysis of PTX3 and hs-CRP with other clinical indicators show that PTX3 and AHI, CK-MB, CTNI positive correlation(r=0.506,0.756,0.766,P<0.001), negatively associated with nadirSpO2(r =-0.468, P <0.001). hs-CRP and AHI, CK-MB,CTNI positive correlation(r=0.258,0.569,0.547,P<0.001),and negatively associated with nadirSpO2(r =-0.236, P <0.001). According to the correlation coefficient PTX3 and AHI, nadirSp O2, CK-MB, CTNI significant correlation.(6) Different types of stratified analysis ACS patient diagnosis(divided STEMI, NSTEMI, UA) found that PTX3, hs-CRP, CK-MB and CTNI in myocardial infarction patients was significantly higher than that of patients with unstable angina, a statistically significant difference(P <0.05), while the diagnosis of AHI and nadirSpO2 different types of ACS patients, the difference was not statistically significant(P> 0.05).(7) According to AHI(AHI 5-15/h as mild, 15-30/h as moderate, 30/h or more severe) the OSAHS disease will be divided into mild, moderate, severe. After stratification analysis showed that PTX3 is lower in mild group than moderate and severe group, the difference was statistically significant(P <0.05), other index have no statistically significant difference(P> 0.05).Conclusions: Elevated serum PTX3 is an independent risk factor for OSAHS patients with ACS,and is more sensitive than hs-CRP in assessing the severity.