探讨血清糖基化终末产物在阻塞性睡眠呼吸暂停低通气综合征患者的水平

To Discuss Serum AGEs Levels in Patients with Obstructive Sleep Apnea Hypopnea Syndrome

目的:观察阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血清糖基化终末产物(AGEs)水平的变化。方法:对95例受试者(男性63例,女性32例)进行整夜的多导睡眠监测,应用分子荧光分析法检测血清AGEs水平。根据中华医学会OSAHS诊治指南,按呼吸暂停低通气指数(AHI),将研究对象分为四组:正常对照组(18例)、轻度OSAHS组(21例)、中度OSAHS组(27例)、重度OSAHS组(29例)。结果:OSAHS组血清AGEs(5.64±2.32)水平明显高于正常组(2.90±0.50,P<0.01);正常组的血清AGEs水平(2.90±0.50)显著低于中度OSAHS组(5.33±1.38,P<0.05)及重度OSAHS组(7.32±2.68,P<0.01);而与轻度OSAHS组(3.90±1.24,P>0.05)无显著差异;在以AHI为依据分组的各组中,AGEs水平随OSAHS的严重程度加重而升高(P<0.05)。对血清AGEs与各参数进行逐步多因素线性回归分析,结果表明呼吸暂停低通气指数和最低血氧饱和度是影响血清AGEs水平的独立因素,血清AGEs水平与呼吸暂停低通气指数呈正相关(β=0.029,P<0.05),血清AGEs水平与最低血氧饱和度呈负相关(β=-0.117,P<0.01)。结论:OSAHS患者血清AGEs水平较正常对照组高,OSAHS本身可能是影响血清AGEs水平的因素之一。

Objective This study was carried out to explore the change of serum AGEs levels in patients with OSAHS. Methods We recruited 95 subjects. Polysomnography was performed in 77 patients with OSAHS （OSAHS group） and 18 simple controls （control group）. The OSAHS group was further divided into mild,moderate and severe OSAHS subgroups. Speetrofluorometric method was used to test serum AGEs levels. Glucose, insulin, and blood pressure （BP） were measured following an overnight fast. Insulin resistance was estimated using homeostasis model assessment （HOMA）. Results Serum AGEs levels was significantly higher in OSAHS group （5.64 ± 2.32 ） than that in the control group （2.90 ± 0. 50, P 〈 0.01 ）. The serum AGEs levels in moderate OSAHS group （5.33 ± 1.38, P 〈 0. 05 ）, severe OSAHS group （7.32 ± 2.68, P 〈 0, 01 ） were greatly higher than those in controls （5.64 ± 2.32 ）. The serum AGEs levels in controls and mild OSAHS group showed no singnificant difference. The serum AGEs levels increased with severity of OSAHS（P 〈0. 05 ）. In order to determine whether these associations were independent of fasting Glucose and other known covariates, a stepwise multiple linear regression analysis adjusted for age, BMI, fasting Glucose, and BP was performed. This demonstrated that AHI and miniO2 was independently associated with increased AGEs. In OSAHS groups, serum AGEs levels were positively correlated with apnea hypopnea index （AHI） （ β =0. 029, P 〈0.05 ）, but negatively correlated with the minimal pulse oxyhemoglobin saturation （ 13 = -0.117, P 〈 0.01 ）. Conclusion Serum AGEs levels are significantly higher than in subjects with OSAHS than that in controls; OSAHS may he one of the causes of increased serum AGEs levels.