Expression Of Vascular Endothelial Injury Factor In Patients With OSAHS

Objective:The expression of vascular endothelial growth factor(VEGF),intercellular adhesion molecule-1(ICAM-1),E-selectin in the serum of patients with the obstructive sleep apnea-hypopnea syndrome(OSAHS)were detected and compared with the non-OSAHS control group.To evaluate the relationship between the serum expression of VEGF,ICAM-1 and E-selectin in patients with different severity of OSAHS and the severity of the disease.The relationship between the expression of VEGF,ICAM-1,E-selectin and apnea hypopnea index(AHI),mean oxygen saturation(MSaO2),lowest oxygen saturation(LSaO2)and the longest time of apnea were analyzed,and whether these endothelial injury factors could be used as indicators to evaluate the severity of OSAHS was discussed.Methods:The study collected the patients who had OSAHS related symptoms or risk factors in Department of Respiratory,the second affiliated Hospital of Kunming Medical University from September 2015 to September 2017.And they were divided into three groups based on the PSG results:severe group(16 cases),mild-moderate group(11 cases)and non-OSAHS group(16 cases)were selected as control group.The diagnosis of OSAHS patients was based on the guidelines for the diagnosis and treatment of obstructive sleep apnea hypopnea syndrome(OSAHS)developed by the Sleep Apnea Disease Section of the Chinese Medical Association(revised edition of 2011).The level of VEGF,ICAM-1,E-selectin in peripheral serum of all OSAHS patients and non-controls were detected by enzyme linked immunosorbent assay(ELISA).To analyze the difference of the expression of VEGF,ICAM-1 and E-selectin in severe group,mild-moderate group and non-OSAHS group.And to analyze the relationship between three factors and apnea hypopnea index(AHI),mean oxygen saturation(MSaO2),the lowest oxygen saturation(LSaO2)and the longest time of apnea.Results:1.The basic data and PSG results of the three groups were compared:there was no significant difference in sex,age and BMI among three groups.The AHI in severe OS AHS group was higher than that of non-OS AHS group and mild-moderate OSAHS group,while LSaO2 was lower than that of non-OSAHS group and mild-moderate OSAHS group.The longest time of apnea in severe OSAHS group was higher than that of non-OSAHS group,but MSaO2 was lower than non-OSAHS group.The AHI and the longest time of apnea in mild-moderate OSAHS group was higher than that of non-OSAHS group,while LSaO2 was lower than that of non-OSAHS group.2.The comparison of the expression levels of serum VEGF?ICAM-1 and E-selectin in three groups:the levels of serum VEGF(P<0.001),ICAM-1(P=0.027)and E-selectin(P(0.001)in severe OSAHS group were higher than those in non-OSAHS group.The level of serum VEGF(P=0.009),E-selectin(P=0.006)in mild-moderate OSAHS group was higher than that in non-OSAHS group.The levels of serum VEGF(P=0.305),E-selectin(P=0.366),ICAM-1(P=0.551)were no significant difference between severe OSAHS group and mild-moderate OSAHS group.The levels of serum ICAM-1(P=0.149)was no significant difference between mild-moderate OSAHS group and non-OSAHS group.3.The correlation analysis of serum levels of VEGF,ICAM-1 and E-selectin with general data and PSG monitoring index3.1 The correlation analysis results:There was no significant correlation between the expression of three endothelial injury factors and sex,age and BMI.The level of serum VEGF was positively correlated with AHI(r=0.428,P=0.004)and the longest time of apnea(r=0.416,P=0.006),and negatively correlated with LSaO2(r=-0.603,P<0.001)and MSaO2(r=-0.582,P(0.001).The level of serum ICAM-1 was positively correlated with the longest time of apnea(r=0.317,P=0.038).The level of serum E-selectin was positively correlated with AHI(r=0.459,P=0.002),and was negatively correlated with LSaO2(r=-0.410,p=0.006).3.2The results of multiple linear stepwise regression analysis:3.2.1 Taking VEGF as dependent variable,and may influencing factor as independent variable,there were two variables of LSaO2 and MSaO2 entering the regression model with a=0.05 as a significant level.(the regression equation is VEGF=572.773-1.485 LSaO2-4.277 MSa02).3.2.2Taking ICAM-1 as dependent variable,and may influencing factor as independent variable,there was one variable of the longest time of apnea entering the regression model with a=0.05 as a significant level.(the regression equation is ICAM-1 =23.832+0.115 the longest time of apnea).3.2.3Taking E-selectin as dependent variable,and may influencing factor as independent variable,there was one variable of AHI entering the regression model with a=0.05 as a significant level.(the regression equation is E-selectin=9.641+0.102 AHI).Conclusion(s):1.The expression of vascular endothelial injury factor in the serum of OSAHS patients was significantly higher than that patients without OSAHS.It indicated that the vascular endothelial was injuried in patients with OSAHS,and the expression level of vascular endothelial injury factor in OSAHS patients increased with the severity of OSAHS patients.2.The expression of VEGF were positively correlated with AHI,the longest time of apnea and negatively correlated with LSaO2,MSaO2.And LSaO2,MSaO2 were the independent factors of VEGF.The expression of ICAM-1 was positively correlated with the longest time of apnea,and the longest time of apnea was an independent factor.E-selectin was positively correlated with AHI and negatively correlated with LSaO2,and AHI was an independent factor of E-selectin.VEGF and E-selectin can reflect the severity of the disease in patients with OSAHS and can be used as a clinical index to judge the severity of the disease.