阻塞性睡眠呼吸暂停低通气综合征： 相关生物标志物的研究进展

Obstructive Sleep Apnea-Hypopnea Syndrome: Research Progress on Related Biomarkers

摘要: 阻塞性睡眠呼吸暂停低通气综合征(OSAHS)作为一类慢性病症，核心表现为夜间睡眠时上气道反复塌陷，在全球成年人群里，患病比例约为10%至30%。其病理生理机制错综复杂，涵盖上气道解剖结构异常、神经肌肉控制障碍、呼吸调控不稳定及觉醒阈值异常四大内表型维度，并通过间歇性低氧驱动氧化应激、慢性炎症、交感神经持续激活及代谢紊乱等全身性损害通路，进而引发心血管、代谢以及认知等多个系统出现相关并发症。随着对OSAHS系统性效应认识的深化，生物标志物研究已从单一炎症指标拓展至涵盖炎症(CRP、IL-6、TNF-α)、氧化应激(GGT、MDA、8-OHdG)、代谢(ApoB、脂联素、瘦素)、凝血与血液流变学(MPV、WMR、NLR)及心血管损伤(NT-proBNP、ADMA)等多维体系。本文系统梳理OSAHS的各类生物标志物的研究进展，重点阐明标志物变化背后的病理生理逻辑，以期为精准筛查、严重程度评估及治疗监测提供理论支撑。本文在系统梳理各类标志物研究进展的同时，引入批判性视角，重点讨论现有研究在方法学、混杂因素控制及结论一致性方面的不足，并在此基础上提出一个多维整合理论框架及基于核心生物标志物的初步临床筛查流程建议，以期为OSAHS的精准诊治提供更具操作性的参考。

Abstract: Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) is a chronic disease characterized by the repeated collapse of the upper airway during nighttime sleep, with a prevalence of approximately 10% to 30% among adults worldwide. Its pathophysiological mechanism is intricate, involving four endophenotypic dimensions: abnormal anatomical structure of the upper airway, neuromuscular control disorders, unstable respiratory regulation, and abnormal arousal thresholds. Driven by intermittent hypoxia, it triggers systemic damage pathways such as oxidative stress, chronic inflammation, sustained sympathetic nerve activation, and metabolic disorders, thereby inducing complications in multiple systems including the cardiovascular system, metabolism, and cognition. With the deepening understanding of the systemic effects of OSAHS, research on its biomarkers has expanded from single inflammatory indicators to a multidimensional system covering inflammation (CRP, IL-6, TNF-α), oxidative stress (GGT, MDA, 8-OHdG), metabolism (ApoB, adiponectin, leptin), coagulation and hemorheology (MPV, WMR, NLR), and cardiovascular injury (NT-proBNP, ADMA). This article systematically reviews the research progress of various biomarkers in OSAHS, focusing on clarifying the pathophysiological logic behind biomarker changes, so as to provide theoretical support for precise screening, severity evaluation and treatment monitoring. While summarizing the research advances of diverse biomarkers, this paper adopts a critical perspective, focusing on discussing the deficiencies of existing studies in methodology, confounding factor control and conclusion consistency. On this basis, it proposes a multi-dimensional integrated theoretical framework and preliminary clinical screening process based on core biomarkers, aiming to offer more operable references for the precise diagnosis and treatment of OSAHS.