阻塞性睡眠呼吸暂停低通气综合征患者瘦素水平及与胰岛素抵抗的关系

The level of serum leptin and its correlation with insulin resistance in OSAHS patients

目的研究阻塞性睡眠呼吸暂停低通气综合征(Obstructive Sleep Apnea-Hypopnea Syndrome,OSAHS)患者的睡眠呼吸紊乱指标与其血清瘦素水平和胰岛素抵抗程度的相互关系。方法参照OSAHS诊治指南[1]选择经确诊为OSAHS的男性患者86例,轻-中度组和重度组各43例。多导睡眠呼吸监测(PSG)结束后测量身高、体重,测定空腹血糖浓度(fasting blood glucoseFBG)、瘦素及胰岛素水平(fasting serum insulin FINS)。采用稳态模型评估法(Homeostasis Model Assessment,HOMA)评价并计算胰岛素抵抗指数(HOMA-IR)。结果重度组的平均和最低血氧饱和度(arterial oxygen saturation SaO2)皆显著低于轻-中度组,BMI、FBG、FINS、血清瘦素水平和HOMA-IR则明显高于轻-中度组,上述指标在两组间比较,皆有显著统计学差异。OSAHS患者血清瘦素水平及HOMA-IR与AHI成正相关,与平均及最低SaO2均存在负相关。OSAHS患者血清瘦素水平与FBG、FINS、HOMA-IR呈正相关。结论在OSAHS患者中,睡眠呼吸功能紊乱和肥胖、瘦素和胰岛素抵抗有关。

Aim To study the correlation between serum leptin level and insulin resistance in OSAHS patients. Methods Eight-six male patients diagnosed as OSAHS with 7 hour PSG monitoring were enrolled in this study. OSAHS were divided into two groups,43 cases in the mild/moderate group and 43 in the severe group. Body height and weight, serum leptin ,fasting blood glucose（FBG） and fasting serum insulin （FINS） were measured and their body mass index （BMI） and HOMA-IR index were calculated afterwards. Results The nocturnal average SaO2 and nocturnal lowest SaO2 were significantly decreased in the severe OSAHS group than those in the mild-moderate group while the BMI, serum leptin level and HOMA index were increased in the former group with statistical significance. In the mild/moderate group and in the severe group, serum leptin level was positively correlated with fasting insulin level and HOMA-IR. Conclusions The extent of respiratory disturbance in OSAHS is closely related with obesity, leptin and other insulin resistance parameters.