经鼻持续气道正压通气治疗对OSAHS患者胰岛素抵抗的影响

Effect of nasal continuous positive airway pressure therapy on insulin resistance in patients with obstructive sleep apnea-hypopnea syndrome

目的探讨经鼻持续气道正压通气(nCPAP)对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者胰岛素抵抗(IR)的治疗价值。方法接受多导睡眠监测的中重度OSAHS患者115例,其中65例接受综合干预治疗6个月为对照组,50例在综合干预治疗的同时接受nCPAP治疗为实验组。在治疗前后分别测定体重指数(BMI)、呼吸暂停低通气指数(AHI)、最低血氧饱和度(miniSpO2)、空腹血糖值和空腹胰岛素值,并计算其胰岛素敏感指数(ISI)。结果治疗前实验组ISI为-4.75±0.44,对照组为-4.78±0.37,两者差异无显著性意义(t=0.021,P>0.05);治疗后实验组(-4.19±028)较对照组(-4.52±0.47)明显升高(t=4.408,P<0.001)。两组ISI与BMI均呈负相关(分别为r=-0.451,P<0.01;r=-0.422,P<0.01),ISI与AHI均呈负相关(分别为r=-0.866,P<0.001;r=-0.829,P<0.001),ISI与miniSpO2均呈正相关(分别为r=0.771,P<0.001;r=0.809;P<0.001)。结论nCPAP能明显改善OSAHS患者的IR。MBI、AHI和miniSpO2可能是nCPAP治疗OSAHS患者IR的有效预测指标。

Objective To investigate the therapeatic effect of nasal continuous positive airway pressure （nCPAP） on insulin resistance （IR） in patients with obstructive sleep apnea-hypopnea syndrome （OSAHS）. Methods One hundrod and fifteen patients with moderate and severe OSAHS （apnea-hypopnea index, AHI≥21 events, hour） underwent overnight polysomnographic （PSG） examinations, of which 65 patients （control group） were treated with conventional intervention treatment for six months, and the other 50 patients （trial group） were treated with nCPAP plus conventional intervention treatment, The values of body mass index （BMI）, AHI, minimal pulse oxygen saturation （miniSpO2）, fasting plasma glucose, and fasting insulin were measured, and the insulin sensitive index （ISI） was calculated in all subjects before treatment and six months after treatment. Results The average values of ISI in trial group -4,75±0,44 and in control group -4,78±0.37 were not significantly different before treatment （P〉0.05）, while the ISI values were significantly higher in trial group than those in control group six months after treatment -4.19±0.28 vs -4.52±0.47 （P〈 0.001）, There was a negative correlation between ISI and BMI in trial group and control group （r=-0,451, P〈0.01; r=- 0.422, P〈0.01）; respectively, ISI and AHI （r=-0.866, P〈0.001; r=-0.829, P〈0.001）; respectively, and a positive correIation between ISI and miniSpO2 in both groups （r=0.771, P〈0.001; r=0.809, P〈0.001）; Conclusion nCPAP therapy could significantly relieve the degree of IR in patients with OSAHS, MBI, AHI and miniSpO2 may be effective predictors for IR on nCPAP therapy for patients with OSAHS.