The Expression Of ICAM-1?PCSK9?ESM-1 And Lipid Metabolism Related Indicators In OSAHS

Research background:Obstructive sleep apnea-hypopnea syndrome(OSAHS)is a sleep disorder with a high incidence,which causes sleep apnea and hypopnea due to upper respiratory tract stenosis or repeated collapse,thus causing systemic multi-system damage.Previous studies have found that about half of OSAHS patients have hypertension,lipid metabolism disorders or other cardiovascular and cerebrovascular diseases,which pose a serious threat to people's public health [1].Chronic intermittent hypoxia(CIH)caused by apnea and hypopnea is an important pathophysiological feature of OSAHS.CIH can lead to oxidative stress,vascular endothelial injury,inflammatory reaction and metabolic disorders in vivo,and trigger a series of cascade reactions and pathophysiological changes.With the deepening of understanding,it is impossible to evaluate the severity of OSAHS only by PSG test results in clinic,which can not assess the occurrence and development of metabolic abnormalities or cardiovascular events associated with OSAHS,and ignore the damage of CIH to the whole pathophysiology of OSAHS.Therefore,detecting and analyzing the hypoxia-related monitoring indicators of OSAHS patients may evaluate the condition of OSAHS from a pathophysiological point of view.At present,CIH-induced vascular endothelial injury is the focus of current research.Scattered studies have found that factors such as Intercelluar adhesion molecule-1 ICAM-1 and ESM-1 are related to the severity of OSAHS,and vascular endothelial injury is the initiating factor of AS.PCSK9 is a protein closely related to the disorder of lipid metabolism and the development of AS.OSAHS is an independent risk factor for abnormal lipid metabolism and AS formation.Previous studies on OSAHS and endothelial cell injury,OSAHS and lipid metabolism disorder or AS have been reported,but the correlation between endothelial cell injury and lipid metabolism disorder in OSAHS patients has not been reported.Whether cascade reaction caused by endothelial cell injury leads to lipid metabolism disorder and further atherosclerosis or cardiovascular and cerebrovascular diseases has not been clarified.research objective:In this study,the expression levels of ICAM-1,ESM-1,PCSK9 and lipid metabolism-related indicators in serum of OSAHS patients were detected and compared with healthy control group.The relationship between the expression of serum ICAM-1,ESM-1,PCSK9 and lipid metabolism-related indicators and the severity of OSAHS,and the expression levels of serum ICAM-1,ESM-1,PCSK9 and lipid metabolism-related indicators in OSAHS patients with different severity were evaluated.Differences between them.To analyze the relationship between ICAM-1,ESM-1,PCSK9 and lipid metabolism related indicators and AHI,CT90,Lowest oxygen suturation(La SO2),Mean oxygen suturation(Ma SO2),in order to explore the relationship among these three factors,abnormal lipid metabolism and OSAHS,and to provide guidance for clinical treatment.Method:Part I: Evaluation of the correlation between serum ICAM-1,ESM-1,PCSK9 levels and the severity of OSAHS.1.From April 2018 to November 2018,OSAHS adult male patients in otorhinolaryngology Department of the Second Affiliated Hospital of Jilin University were selected.According to the results of PSG,18 cases in severe group,13 cases in mild and moderate group,and 15 cases in healthy group were selected as control group.The diagnosis of OSAHS patients is based on the Guidelines for Diagnosis and Treatment of Obstructive Sleep Apnea Hypopnea Syndrome(OSAHS)developed by the Otolaryngology Head and Neck Surgery Society of Chinese Medical Association in 2009.2.The levels of ICAM-1,ESM-1 and PCSK9 in peripheral serum of all OSAHS patients and healthy controls were measured by ELISA.The corresponding concentrations were calculated from the standard curve according to their OD values.3.Statistical processing: All data were analyzed by SPSS17.0 statistical software package,with statistical significance of P < 0.05.Part II: Evaluation of the correlation between dyslipidemia and OSAHS,serum ICAM-1,ESM-1 and PCSK9 levels Part II: Evaluation of the correlation between dyslipidemia and OSAHS,serum ICAM-1,ESM-1 and PCSK9 levels1.From April 2018 to January 2019,31 adult male OSAHS patients and 15 healthy controls were diagnosed by PSG in the Department of Otolaryngology,the Second Affiliated Hospital of Jilin University.The criteria of dyslipidemia were established by the Joint Committee for the Prevention and Treatment of Adult Hyperlipidemia in China.2.The levels of ICAM-1,ESM-1 and PCSK9 in peripheral serum of all OSAHS patients and healthy control group were measured by ELISA.The blood lipid test was sent to the Laboratory Department of the Second Affiliated Hospital of Jilin University.3.The statistical method is the same as the first part.Result:Part I:1.There was no significant difference among the three groups in age comparison.BMI of severe OSAHS group and mild-moderate OSAHS group was higher than that of healthy control group,while BMI of severe OSAHS group was not significantly different from that of mild-moderate group.The results of PSG monitoring indexes AHI,LSa O 2,MSa O 2 and CT90 in severe OSAHS group were significantly different from those in mild and moderate OSAHS group.2.The expression levels of serum ICAM-1(P<0.001)and PCSK9(P=0.018)in severe OSAHS group were significantly higher than those in control group,and the expression levels of serum ICAM-1(P=0.017)and PCSK9(P=0.002)in mild and moderate OSAHS group were significantly higher than those in control group.There was no significant difference in the expression levels of serum ESM-1 between severe OSAHS group,mild and moderate OSAHS group and control group.There was no significant difference in serum ICAM-1(P=0.131),ESM-1(P=0.125)and PCSK9(P=0.329)levels in moderate OSAHS group.3.The results of correlation analysis between age,BMI,AHI,LSa O 2,MSa O 2,CT90 and serum expression levels of ICAM-1 ESM-1 and PCSK9 showed that there was no significant correlation between serum expression levels of ICAM-1,ESM-1and PCSK9 and age.ICAM-1 serum expression level was positively correlated with AHI(r=0.447,P=0.007)and negatively correlated with MSa O 2(r=-469,P=0.008).4.With ICAM-1 as dependent variable and the possible influencing factors as independent variable,the multivariate linear stepwise regression analysis method was adopted.The significance level was_=0.05.Only the variables with AHI entered the regression model,and the regression equation was ICAM-1=0.069AHI+8.566.Part II:1.The incidence of dyslipidemia was 70.97%(22/31)in OSAHS group,33.3%(5/15)in control group,5.906,= 5.906,P = 0.025.There was significant difference between the two groups.The incidence of dyslipidemia was 66.6%(12/18)in severe OSAHS group and 76.9%(10/13)in mild and moderate OSAHS group,P = 0.219.2.There was no significant difference between OSAHS group and control group in age(P=0.486),TG(P=0.951),HDL-C(P=0.959),LDL-C(P=0.371),ESM-1(P=0.185).There were significant differences between OSAHS group and control group in BMI(P < 0.001),TC(P = 0.026),PCSK9(P = 0.02),ICAM-1(P < 0.001).3.The correlation between the severity of OSAHS and lipid metabolism: TG(P=0.135),TC(P=0.108),HDL-C(P=0.647),LDL-C(P=0.812)had no significant difference between severe OSAHS group and mild to moderate OSAHS group.4.Risk factors analysis of OSAHS dyslipidemia group and OSAHS normal blood lipid group: There were significant differences between OSAHS dyslipidemia group and OSAHS normal blood lipid group in TG(P=0.002),TC(P=0.038).There were no significant differences in age(P=0.938),BMI(P=0.388),HDL-C(P=0.555),LDL-C(P=0.209),PCSK9(P=0.067),ICAM-1(P=0.110),ESM-1(P=0.620),AHI(P=0.267),LSa O 2(P=0.885),MSa O 2(P=0.713),CT90(P=0.675).5.The results of correlation analysis of TG,TC,HDL-C,LDL-C levels with general data and PSG monitoring indicators showed that TC value was weakly positively correlated with AHI(r=0.232,P=0.042),PCSK9 was positively correlated with TC(r=0.597,P=0.001)and LDL-C(r=0.606,P=0.023),and the remaining indicators had no correlation and statistical significance.Conclusion:1.Adult male patients with OSAHS have vascular endothelial injury and dysfunction,which can increase the expression of ICAM-1 in serum.2.The serum ICAM-1 level in adult male patients with OSAHS is related to the severity of OSAHS,which may be a new index for evaluating the severity of OSAHS.3.Adult male OSAHS patients are more likely to suffer from dyslipidemia than healthy people,but lipid metabolism related indicators are not related to the severity of OSAHS and the expression of vascular endothelial injury related factors.4.Serum PCSK9 levels in adult male OSAHS patients were positively correlated with TC and LDL-C levels.The mechanism may be that the increase of PCSK9 expression in blood circulation promotes the occurrence of abnormal lipid metabolism.