不同低氧模式对Spraue-Dawley大鼠低位脑干5-HT〓与5-HT〓受体表达的影响 目的：在阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的发病机制中，中枢因素起着重要的作用。OSAHS所继发的低氧和高CO₂反过来也影响呼吸中枢的功能。5-HT及其受体对呼吸的调节具有重要作用，与OSAHS的发生存在密切联系。其中5-HT〓与5-HT〓是中枢5-HT兴奋性受体。为探讨低氧和高CO₂对呼吸中枢的影响，本研究试图通过模拟OSAHS继发的低氧与高CO₂这一病生理异常，来探讨这一异常是否可对大鼠呼吸中枢5-HT〓与5-HT〓受体表达产生影响。 方法：成年雄性Sprague-Dawley大鼠36只，随机分为四组，每组各9只。正常对照组(normal control，NC)：每天吸入空气；持续低氧组(continuous hypoxia， CH)：每天持续吸入10.0%O₂ 6小时；间歇低氧组(intermittent hypoxia，IH)吸入30s 10.0% O₂、30s正常浓度O₂，60s一循环，6小时/天；间歇低氧伴高CO₂组(intermittent hypoxia with hypercapnia，IHH)：吸入 30s 10.0% O₂ 和 5.5%CO₂、30s正常浓度O₂和CO₂，60s 一循环，6小时/天。2周后取静脉血处死大鼠，送检血常规，留取低位脑干(延髓)组织标本。用Western blot的方法检测低位脑干中的5-HT〓与5-HT〓受体表达量并比较四组大鼠间5-HT〓与5-HT〓受体表达量的差异。 结果：CH组血红蛋白浓度(hemoglobin，Hb)为(191.44±10.10) g/L，红细胞比容(hematocrit，HCT)为(56.53±3.98) %，均显著高于其他三组(P＜0.01)； IH组的 RBC、Hb 和HCT 分别为(81.36±4.68)×10¹¹/L，(163.55±6.97)g/L，(46.52±2.15) %，均高于NC组(P＜0.05) ； IHH组的 RBC、Hb 和HCT 分别为(77.06±4.26)×10¹¹/L， (158.56±4.28) g/L ， (45.22±1.46)%，与 NC 组比较均无显著性差异(P＞0.05)。NC、CH、IH、IHH组大鼠脑干5-HT〓受体表达量分别为0.158±0.041，0.164±0.071，0.181±0.038，0.215±0.054；5-HT〓受体表达量分别为0.422±0.161，0.680±0.402， 1.204±0.228，1.093±0.385。IHH 组 5-HT〓与5-HT〓受体的表达量均高于NC组与CH组(P＜0.05)，IH组5-HT〓受体表达量高于NC组与CH组(P＜0.01)，而IH组5-HT〓受体表达量与NC组、CH组之间无显著性差异(P＞0.05)。IH组与IHH组之间、CH组与NC组之间这两种受体的表达量均无显著性差异(P＞0.05)。 结论：不同低氧模式对大鼠脑干5-HT〓与5-HT〓受体的表达存在不同影响。模拟OSAHS的间歇低氧伴高CO₂可导致大鼠低位脑干5-HT〓与5-HT〓受体表达增加，可能是机体为了增强通气作出的代偿机制之一，提示OSAHS可能也存在相似的继发改变。 【关键词】：阻塞性睡眠呼吸停低通气综合征(OSAHS)；5-HT受体；低氧；高CO₂ Epworth嗜睡量表在阻塞性睡眠呼吸暂停低通气综合征筛查中的应用价值 目的：评价Epworth嗜睡量表对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的筛查价值。 方法：以340例疑诊OSAHS患者为研究对象，均进行Epworth嗜睡量表(ESS)评分及多导睡眠图(PSG)监测。根据PSG监测结果将340例患者分为鼾症组及轻、中、重度OSAHS组，比较四组间ESS评分及ESS评分≥9分患者所占比率的差异。对ESS评分与患者的年龄、体重指数(BMI)、呼吸暂停低通气指数(AHI)、最低脉氧饱和度(SpO₂)、微觉醒指数之间进行相关性分析。利用受试者工作特征(ROC)曲线评价ESS评分对OSAHS的诊断价值。 结果：ESS评分随着OSAHS病情的加重有逐渐增高的趋势，四组患者的ESS评分分别为：9.96±4.81 ， 10.21 ±5.48，11.48±5.28，13.52±5.84，只有重度OSAHS患者的ESS评分与其他组的差异有统计学意义(P＜0.05)；四组中ESS≥9分患者所占的比率分别为64.9%、60.5%、69.6%、76.6%，差异无统计学意义(P＞0.05) ； ESS评分与AHI存在低度正相关(r=0.240，P＜0.01)，与最低SpO₂存在低度负相关(r=-0.198，P＜0.01)，与年龄、BMI及微觉醒指数均无相关关系(P＞0.05) ； ROC曲线分析结果发现曲线下面积为0.601，且难以得出最佳诊断分值。ESS评分≥9分筛选OSAHS的灵敏度为70.0%，特异性为35.1%。 结论：ESS评分对重度OSAHS患者的病情判断具有一定意义，但不能准确反映轻中度OSAHS患者的病情严重程度，以ESS≥9分来筛查OSAHS并不可靠。ESS评分用于OSAHS病情的筛选与评价有其局限性，对OSAHS的筛查需要制定更加全面有效的评分系统。 【关键词】Epworth嗜睡量表；阻塞性睡眠呼吸暂停低通气综合征；筛查

 The Influence of different hypoxia modes on the expression of 5-HT〓 and 5-HT〓 receptors of the lower brainstem in Sprague-Dawley rats Objective: The central mechanisms play an important part in the pathogenesis of obstructive sleep apnea-hypopnea syndrome (OSAHS). The hypoxia and hypercapnia secondary to OSAHS can also influence the function of respiratory centre. The serotonin and serotonin receptors play an important role in the modulation of breathing and have a close association with the pathogenesis of OSAHS. The 5-HT〓 and 5-HT〓 receptors belong to excitatory serotonin receptors in the central neural system. In order to investigate the influence of hypoxia and hypercapnia on the function of respiratory centre, this study was designed to simulate the hypoxia and hypercapnia secondary to OSAHS and investigate whether these pathophysiologic abnormalities can influence the expression of 5-HT〓 and 5-HT〓 receptors of the lower brainstem in rats. Methods: 36 adult male Sprague-Dawley (SD) rats were divided into 4 groups and 9 of each. Rats of normal control group (NC) were exposed to normal air. Rats of continuous hypoxia (CH) group were continuously exposed to 10% O₂ for 6h/day. Rats of intermittent hypoxia (IH) group were exposed to 30s of 10% O₂ followed by 30s of normoxia and this pattern was repeated 60 times/h, 6 h/day. Rats of intermittent hypoxia with hypercapnia (IHH) group were exposed to 30s of 10% O₂ with 5.5% CO₂ followed by 30s of normoxia with normal CO₂ and this pattern was repeated 60 times/h, 6 h/day. After 2 weeks, all of the rats were sacrificed and the lower brainstems (medulla oblongata) were collected. The expressions of 5-HT〓and 5-HT〓 receptors of the lower brainstems were measured semi-quantitatively by western blot. Results: The Hb and HCT levels of CH group were (191.44±10.10) g/L and (56.53±3.98) % and both of them were significantly higher than those of the other three groups (P＜0.01). The RBC count, Hb and HCT levels of IH group were(81.36±4.68)×10¹¹/L, (163.55±6.97) g/L and (46.52±2.15) % and all of them were significantly higher than those of NC group (P＜0.05). The RBC count, Hb and HCT levels of IHH group were (77.06±4.26)×10¹¹/L, (158.56±4.28) g/L and (45.22 ±1.46) % and all of them had no significant difference from those of NC group (P＞0.05).The quantities of 5-HT〓 receptor in the lower brainstem of NC, CH, IH and IHH groups were 0.158±0 .041, 0.164±0.071, 0.181 ±0.038 and 0.215±0.054,reapectively. The quantities of 5-HT〓 receptor were 0.422±0.161, 0.680±0.402, 1.204±0.228 and 1.093 ±0.385,respectively. The quantities of 5-HT〓 and 5-HT〓 receptors of IHH group were significantly higher than those of NC and CH groups (P＜0.05). The quantity of 5-HT〓 receptor of IH group was higher than that of NC and CH groups (P＜0.01), but the quantity of 5-HT〓 receptor of IH group had no significant difference from that of NC and CH groups (P＞0.05). The quantities of the two receptors in CH group had no significant difference from those of NC group (P＞0.05). The quantities of the two receptors in IH group had no significant difference from those of IHH group (P＞0.05). Conclusions: The influence of different hypoxia modes on the expression of 5-HT〓 and 5-HT〓 receptors of the lower brainstem in SD rats was different. The simulated intermittent hypoxia with hypercapnia secondary to OSAHS could enhance the expression of 5-HT〓and 5-HT〓 receptors of the lower brainstem and that maybe one of the compensative mechanisms for the ventilation enhancement. These results indicated that OSAHS may also have the analogical changes. [ Key words ] : obstructive sleep apnea-hypopnea syndrome; 5-HT receptors; hypoxia; hypercapnia Application value of Epworth sleepiness scale in the screening of obstructive sleep apnea-hypopnea syndrome. Objective: To evaluate the value of Epworth sleepiness scale (ESS) on screening patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods: 340 cases with suspected OSAHS were enrolled in the study. The sleep questionnaire including ESS was obtained and polysomnography (PSG) was used to make or exclude the diagnosis of OSAHS. According to the PSG monitoring results the 340 cases were classified into habitual snorers, mild, moderate and severe OSAHS group. The average ESS scores and the percentages of patients whose ESS score was≥9 were compared among the four groups. The correlation of ESS scores with age, body mass index (BMI), apnea-hypopnea index (AHI), the lowest SpO₂ and microarousal index was analyzed. The diagnostic value of ESS score was evaluated by Receiver Operating Characteristic (ROC) curve. Results: The ESS scores had an ascending tendency as the severity of OSAHS increased. The means±SD of ESS score in the four groups were 9.96±4.81, 10.21± 5.48, 11.48±5.28 and 13.52±5.84,respectively.Only ESS scores of the severe OSAHS group was significantly higher than the other three groups (P＜0.05).The percentages of cases with ESS scores≥9 in the four groups were 64.9%, 60.5%, 69.6% and 76.6%, respectively and no significant difference was found among the four percentages (P＞0.05).The ESS scores had a weak positive correlation (r=0.240, P＜0.01) with the apnea-hypopnea index (AHI) and a weak negative correlation (r=-0.198, P＜0.01) with the lowest SpO₂.The ESS scores had no correlation with age, BMI or the microarousal index (P＞0.05). The ROC curve showed the area was not large (0.601) and the best cutoff point could not be obtained. When ESS score ≥9 was used as the cutoff point for OSAHS diagnosis, the sensitivity was 70.0% and the specificity was 35.1%. Conclusions: The ESS score has a limited value in evaluating the severity of severe OSAHS patients but can not exactly reflect the severity of mild or moderate OSAHS patients. The ESS scored≥9 as a cutoff point is not reliable in screening OSAHS. A more effective scoring system need to be established for the better screening of OSAHS patients. [ Key words ] Epworth sleepiness scale; Obstructive sleep apnea-hypopnea syndrome; Screening