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研究生:邱國樑
研究生(外文):Chiu, Kuo-Lang
論文名稱:阻塞性睡眠呼吸中止症候群患者血管內皮生長因子與低血氧之關係探討
論文名稱(外文):Vascular Endothelial Growth Factor in Obstructive Sleep Apnea Syndrome With Hypoxemia
指導教授:陳祖裕陳祖裕引用關係蔡熒煌蔡熒煌引用關係徐武輝徐武輝引用關係
學位類別:碩士
校院名稱:中國醫藥學院
系所名稱:醫學研究所
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2002
畢業學年度:90
語文別:中文
論文頁數:50
中文關鍵詞:阻塞性睡眠呼吸中止症候群血管內皮生長因子低血氧
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睡眠呼吸中止症候群(sleep apnea syndrome)爲近數十年來逐漸爲人所瞭解的一種疾病,患者在睡眠中會發生反覆的呼吸暫停,因而導致睡眠中反覆的覺醒(arousals),或同時引起低血氧的現象。根據研究顯示,有些患者之長期存活率有明顯下降,但經過適當治療後其存活率可有顯著改善。
許多研究顯示,患者在睡眠中因為呼吸暫停或低下,而引發低血氧及血行動力的變化,同時也顯示此疾病與高血壓、心血管疾病、及中風有明顯關係。當體內暴露在低血氧狀態下會引發許多反應,其中血管內皮生長因子的生成即會被組織缺氧所刺激而增加,因而能刺激血管新生。因此我們設計了本研究,以進一步了解這類患者低血氧的狀態下,血管內皮生長因子的變化,來嘗試了解心血管系統在此疾病之部分反應機轉。
本研究由臨床睡眠檢查室中篩選40位受檢者,進行睡眠多項生理檢查,並檢測其血中血管內皮生長因子及乳酸之濃度。依其睡眠多項生理檢查之結果分成三組:正常組(A組)、無嚴重低血氧之阻塞型睡眠呼吸中止症候群患者組(B組),及有嚴重低血氧之阻塞型睡眠呼吸中止症候群患者組(C組)。取受檢者之睡前及次日清晨睡醒後之靜脈血液標本,分析其血管內皮生長因子及乳酸濃度。結果顯示在睡前A組之血中血管內皮生長因子濃度為43.6 ± 29.3 pg/ml,雖較B組的66.7 ± 38.7 pg/ml及C組的58.9 ± 20.1 pg/ml低,但未達統計學上的意義;而在睡醒時在A組顯著地下降至23.8 ± 14.1 pg/ml(p = 0.0129),在B組顯著地下降至45.2 ± 34.3 pg/ml(p = 0.001),C組則下降至41.3 ± 26.5 pg/ml,但未達統計意義。在睡醒時之血管內皮生長因子濃度在三組之間並未有顯著的差異。至於乳酸濃度,在睡前三組依次為9.6 ± 5.6、11.9 ± 5.8及12.7 ± 3.9 mg/dl(p > 0.05),在睡醒時A組下降至7.0 ± 4.3 mg/dl,但與睡前比較未達統計學上差異;在B組及C組則分別為13.3 ± 5.7及14.3 ± 3.9 mg/dl,與睡前相較尚未達統計學上差異。然而在睡醒時A組的乳酸濃度顯著地低於B組(p = 0.005)及C組(p = 0.004)。
本研究結果顯示,國人不同程度之阻塞性呼吸中止症候群患者與正常組血中之血管內皮生長因子濃度不論在睡前或睡醒,並無統計學上顯著的差異。此結果與國外研究結果不同。乳酸濃度檢測結果也顯示,三組睡前濃度並無差異,但睡醒時,正常組之乳酸較其他二組有顯著之降低。其中的意函必須做更大規模的研究來加以詮釋。
Sleep apnea syndrome has been noted since recent several decades. Its characteristic is repeated apneas during sleep that cause arousals. Because of sleep fragmentation, patients have excessive daytime sleepiness. Many studies had shown the relationship between sleep apnea and hypertension, cardiovascular disorders, and stroke. Higher mortality among patients with obstructive sleep apnea syndrome in some study, but it is reduced after adequate therapy.
The most common symptoms are snoring, choking, gasping, unrefreshed sleep, and excessive daytime sleepiness. Some patients seek medical consultation due to witnessed apnea during sleep.
Polysomnography (PSG) is the gold standard to diagnose sleep apnea syndrome. It can record many parameters, including sleep stages, breathing, heart beats, and pulse oximetry.
The mechanism of cardiovascular disorders in sleep apnea is not fully known, but it may be due to the hypoxemia and hemodynamic change during sleep apnea. Many reactions will be induced by hypoxia, and one of them is the vascular endothelial growth factor (VEGF) production. To make clear the relationship between VEGF and sleep apnea may help to understand more about the pathophysiology of cardiovascular disorder of sleep apnea patients.
In this study, we collect 40 candidates who performed polysomnography. Three groups were separated according to the PSG. Group A was defined as normal group with normal PSG. Group B was defined as obstructive sleep apnea without severe hypoxemia. Group C was defined as obstructive sleep apnea with severe hypoxemia. Blood sampling were drawn before and after sleep for vascular endothelial and lactate level tests.
The results shows there is no significant difference between VEGF and lactate level among these three group eventhough they had marked difference in desaturation. This result is different to some previous study in the Western population. We conclude that there may be difference in the response to hypoxemia between Eastern and Western populations, or we need other more sensible marker. We suggest more and large-sized studies to make clear that if there is any relationship between the different severity of hypoxemia and VEGF production.
目錄
內容 頁次
誌謝 ------------------------------------------------ 1
中文摘要 ------------------------------------------------- 2
目錄 --------------------------------------------- 4
表目錄 ------------------------------------------------ 5
圖目錄 ---------------------------------------------- 6
符號與縮寫 ---------------------------------------------- 7
主文
I背景介紹 ----------------------------------------------- 8
II研究動機與目的 --------------------------------------- 15
III材料 -------------------------------------- 16
IV方法 -------------------------------------- 17
V結果 ----------------------------------------------- 22
VI討論 ---------------------------------------------- 25
VII結論 ------------------------------------------------ 28
VIII考文獻 ---------------------------------------------- 29
IX英文摘要 ---------------------------------------------- 47
X作者簡歷 ---------------------------------------------- 48
表目錄
表一、受檢者的基本資料
圖目錄
圖一、三組受檢者睡前及睡醒時之血漿內血管內皮生長因子濃度差異
圖二、三組受檢者睡前及睡醒之血漿內乳酸濃度差異
圖三、睡前乳酸濃度與低血氧程度關係
圖四、睡醒時乳酸與低血氧程度關係
圖五、睡前血管內皮生長因子與呼吸中止低下指數關係
圖六、睡醒後血管內皮生長因子與呼吸中止低下指數關係分布
圖七、睡前血管內皮生長因子與低血氧關係分布圖
圖八、睡醒後血管內皮生長因子與低血氧關係分布圖
圖九、睡前血管內皮生長因子與最低血氧飽和度關係分布圖
圖十、睡醒後血管內皮生長因子與最低血氧飽和度關係分布圖
圖十一、睡前時乳酸濃度與血管內皮生長因子濃度關係分布圖
圖十二、睡醒時乳酸濃度與血管內皮生長因子濃度關係分布圖
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