阻塞性睡眠呼吸暂停综合征患者血清瘦素水平与胰岛素抵抗的关系

Relationship of leptin and insulin resistance in patients with obstructive sleep apnea syndrome

目的:探讨阻塞性睡眠呼吸暂停综合征(OSAS)患者血清瘦素水平及其与胰岛素抵抗(IR)的关系.方法:测量研究对象的身高、体质量,行多导睡眠图(PSG)检查.根据睡眠呼吸暂停低通气指数(AHI)和体块指数(BMI)将研究对象分为四组:A组肥胖OSAS患者16例(BMI≥27,AHI≥5);B组非肥胖OSAS患者10例(BMI<25,AHI≥5);C组单纯肥胖10例(BMI≥27,AHI<5);D组对照10例(BMI<25,AHI<5).瘦素及胰岛素测定采用放免法,血糖采用葡萄糖氧化酶法.结果:①A,B,C三组空腹胰岛素水平分别为(15.6±3.6),(11.7±2.3),(11.3±2.5)mU/L,均较D组(9.1±1.8)mU/L升高(P<0.01),且A组胰岛素也显著高于B,C组(P<0.01);②A,B,C三组瘦素水平分别为(6.6±1.4),(4.7±0.9),(4.2±0.7)μg/L均较D组(3.4±1.0)μg/L非常显著升高(P<0.05～0.01),且A组瘦素也显著高于B,C(P<0.01);③A,B,C三组稳态模式估计法(HOMA)胰岛素抵抗指数(HOMAIR)分别为(4.0±1.4),(3.0±0.8),(2.8±0.6),均较D组显著升高(2.1±0.6)(P<0.05～0.01),且A组HOMAIR也显著高于B,C组(P<0.01);④OSAS患者血清瘦素水平与空腹胰岛素水平,BMI,HOMAIR正相关,相关系数分别为:0.4074(P<0.05),0.7543(P<0.01),0.4312(P<0.05),0.4352(P<0.05).结论:OSAS患者血清瘦素水平及HOMA胰岛素敏感指数明显高于单纯肥胖组及对照组,OSAS患者体内瘦素水平可能与其IR有关.

AIM： To explore the relationship between serum leptin level and insulin resistance in patients with obstructive sleep apnea syndrome （ OSAS ）. METHODS： Polysomnography was performed in all the enrolled cases, which were divided into four groups by body mass index （BMI）and apnea hypopnea index （AHI） ： group A obese OSAS（BMI≥27, AHI≥5）, group B non-obese OSAS （BMI 〈25, AHI≥5）, group C simple obese （BMI≥27, AHI 〈5）and group D normal control （ BMI 〈 25, AHI 〈 5）. Fasting plasma glucose （FPG） levels were measured by glucoseoxidase, fasting insulin （FINS） and fasting leptin levels were measured by radioimmunoassay. RESULTS： ①The serum insulin levels in groups A, B and C [ （15.6 ＋3.6）, （11.？＋2.3）, （11.3_＋2.5） mU/L] were higher thanthat of group D [ （9. l _＋ l. 8） mU/L, P〈0 0l ] and the insu-lin level in group A was higher than those in groups B and C（P〈0.0I）. ②The serum leptin levels in groups A, B and C [（6.6±1.4）, （4.7±0.9）, （4.2±0.7）μg/L] werehigher than that in group D [（3.4±1.0）μg/L, P〈0.05 -0.01 ] and the leptin level in group A was higher than those in groups B and C（ P 〈 0.01 ）. ③The HOMA-IR in groups A, B and C （4.0±1.4, 3.0±0.8, 2.8±0.6） was higher than that in group D （2.1 ± 0.6） （ P 〈 0.05 - 0.0l ） and HOMA-IR in group A was higher than those in groups B and C （ P 〈 0.0l ）. ④The leptin levels in the OSAS patients were obviously correlated with BMI, insulin and HOMA-IR. CONCLUSION： Fasting plasma leptin level is closely related with the insulin resistance in patients with OSAS.