合并2型糖尿病的阻塞性睡眠呼吸暂停综合征患者血管活性物质的变化

Changes of vasoactive substance in obstructive sleep apnea syndrome patients with type 2 diabetes

目的探讨合并2型糖尿病（type 2 diabetes mellitus,T2DM）的阻塞性睡眠呼吸暂停综合征（obstructive sleep apnea syndrome，OSAS）患者与T2DM患者、与OSAS患者相比血管活性物质的变化。方法选取OSAS患者50例，其中合并T2DM组24例，单纯OSAS组26例，另选18例T2DM组，同时选取健康成年人24名作为对照组。用ELISA方法测定各组的血清一氧化氮（NO）、内皮素-1（ET-1）、血栓素A2 （TXA2）及超敏C反应蛋白（hs-CRP）的水平，比较各组间血清NO、ET-1、TXA2、hs-CRP水平的变化，并进一步将上述指标与呼吸暂停低通气指数（AHI）做相关分析。结果 四组间的一般情况比较无明显差异，单纯OSAS组与对照组相比、OSAS合并T2DM组与T2DM组比较空腹血糖无明显差异。四组间多导睡眠监测结果的比较：OSAS组与OSAS合并T2DM组AHI明显升高，最低血氧下降，且OSAS合并T2DM组夜间血氧下降更明显。各组间血管活性物质的比较：OSAS两组及单纯T2DM组与对照组比较：NO水平降低，ET-1、TXA2、hs-CRP水平升高，NO/ET-1比值下降（P值均＜0.01）,OSAS合并T2DM组与单纯OSAS组比较NO水平降低、ET-1、TXA2水平升高，NO/ET-1比值下降（P值均＜0.01）;OSAS合并T2DM组与T2DM组比较：NO水平降低、ET-1、TXA2水平升高，NO/ET-1比值下降（P值均＜0.01）。且OSAS合并T2DM患者NO水平降低、ET-1、TXA2水平升高,NO/ET-1比值下降更明显。单纯OSAS患者与单纯T2DM组比较，NO、ET-1、TXA2、hs-CRP水平及NO/ET-1比值差异无统计学意义。OSAS两组组内相关分析结果：AHI与NO水平呈负相关（r=-0.760,P＜0.01）、与ET-1水平呈正相关（r=0.892,P＜0.01）、与TXA2水平呈正相关（r=0.636，P＜0.01）、与NO/ET-1比值呈负相关（r=-0.769,P＜0.01）、与hs-CRP水平呈正相关（r=0.773,P＜0.01）。结论OSAS患者存在明显的血管内皮功能紊乱，合并T2DM时更为明显。

Objective To investigate the changes of vasoactive substance in obstructive sleep apnea syndrome （OSAS） patients with type 2 diabetes and type 2 diabetes mellitus （T2DM） and OSAS patients.Methods 50 cases of OSAS confirmed by polysomnography （PSG） were selected, which included 24 patients with type 2 diabetes and 26 without type 2 diabetes. 18 patients with type 2 diabetes were selected and 24 normal controls selected as the control group. Serum levels of nitric oxide （NO）,endothelin 1 （ET-1）, thromboxane A2 （TXA2）, and high-sensitive C-creative protein （hs-CRP） in patients were detected by enzyme-linked immunosorbent assay （ELISA）. Then we analysed the relativity between the changed above index and apnea-hypopnea index （AHI）. Results ①AHI significantly elevated hs-CRP in patients with OSAS and the lowest oxygen saturation declined and the OSAS with T2DM more evident. ②Compared vasoactive substances between OSAS group and T2DM group with control group,serum levels of ET-1, hs-CRP, TXA2 were higher in patients with OSAS patients and T2DM patients than those in control group, and the level of NO and NO/ET-1 decreased in OSAS patients and T2DM patients. Then we found the changes more significant in OSAS with T2DM patients except for hs-CRP. ③In OSAS patients, the level of ET-1,TXA2 and hs-CRP has positive correlation with AHI and the level of NO and NO/ET-1 has negative correlation with AHI. Conclusions The results indicate that the patients with OSAS have obvious endothelial dysfunction, and the changes in OSAS with T2DM patients more severe.