阻塞性睡眠呼吸暂停低通气综合征患者代谢紊乱的临床观察

Clinical observations of metabolic disturbance in patients with obstructive sleep apneahypoventilation syndrome

目的探讨阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea-hypopnea syndrome，OSAHS）与胰岛素抵抗的相互关系以及引起代谢综合征的作用机制。方法随机选择186例住院的原发性高血压病患者，根据夜间多导联睡眠图检测结果分成4组，对照组35例，轻度OSAHS组61例，中度OSAHS组52例，重度OSAHS组38例。对所有患者测量身高、体重、腰围、血压、血脂、空腹血糖、空腹胰岛素、血尿酸和肌酐，比较并分析4组间各变量。结果102例（67．6％）OSAHS患者患有代谢综合征，重度OSAHS组中33例（86．8％）符合代谢综合征诊断，与对照组比较差异有统计学意义（P〈0．01）。重度OSAHS组的体重指数、腰围、血尿酸／肌酐比值、舒张压均明显高于对照组和轻、中度OSAHS组（P〈0．01）。重度OSAHS组的收缩压明显高于轻、中度OSAHS组（P〈0．01）。重度OSAHS组的胰岛素抵抗明显高于对照组和轻度OSAHS组（P〈0．01）。多元回归分析表明，胰岛素抵抗与体重指数呈正相关，与最低血氧饱和度呈负相关；最低血氧饱和度与腰围和血尿酸／肌酐比值呈负相关。结论低氧血症和肥胖促进胰岛素抵抗的发生和发展。高血压病合并OSAHS患者容易出现代谢综合征，尤其是在重度OSAHS患者。

Objectives To investigate the relationship between obstructive sleep apnea hypoventilation syndrome （OSAHS）, insulin resistance （IR） and metabolic syndrome （MS）, as well as to explore the possible mechanism of MS caused by OSAHS. Methods We recruited 186 hospitalized patients with hypertensions, who were divided into four groups based on their nocturnal polygraphs recordings, 35 as controls （group Ⅰ）, 61 with mild （group Ⅱ）, 52 with moderate （group Ⅲ） and 38 with severe OSAHS （group Ⅳ）. They all underwent measurements including body height, body weight, waist circumference （WC）, systolic and diastolic blood pressure （SBP and DBP）, serum uric acid, creatinine, fasting plasma glucose, fasting plasma insulin, serum total cholesterol, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol and triglyceride. Results One hundred and two patients with OSAHS （67.6 percent） also suffered of MS, 33 （86. 8 percent） of them with severe OSAHS. There was no significant difference in age, gender, fasting plasma glucose, total cholesterol, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol and triglyceride among the four groups （P 〉 0. 05 ）. Body mass index （ BMI）, WC, ratio of serum uric acid to creatinine and DBP were all significantly higher in patients with severe OSAHS than those in patients with mild and moderate OSAHS and controls （P 〈 0. 01 ）. SBP was significantly higher in patients with severe OSAHS than that in those with mild and moderate OSAHS （ P 〈 0. 01 ）. Insulin resistance was significantly severer in patients with severe OSAHS than that in those with mild OSAHS and controls （P 〈 0. 01 ）. Results of multivariate linear regression analysis showed that insulin resistance was correlated with BMI and reversely correlated with minimal blood oxygen saturation, and minimal blood oxygen saturation reversely correlated with WC and ratio of uric acid to creatinine. Conclusions Hypoxemia and obesity may promote development of insulin resistance. Patients of hypertension complicated with OSAHS tend to develop MS, particularly in those with severe OSAHS.