阻塞性睡眠呼吸暂停低通气综合征患者血清脂联素水平的研究

Adiponectin in patients with obstructive sleep apnea syndrome

目的探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者血清脂联素水平和胰岛素抵抗变化及脂联素下降的相关危险因素。方法选择主诉打鼾的患者共80例，分为对照组、轻度OSAHS组、中度OSAHS组、重度OSAHS组，分析比较不同组间血清脂联素水平和胰岛素抵抗指数（HOMA—IRI）的变化以及OSAHS患者中血清脂联素与呼吸暂停低通气指数（AHI）、缺氧程度、微觉醒指数、睡眠结构等临床指标的相关性。结果与对照组、轻度OSAHS组、中度OSAHS组相比，重度OSAHS组血清脂联素水平[（5．44±2．57）mg／L]下降而HOMA—IRI（3．42±0．70）升高（P〈0．05）。OSAHS患者中血清脂联素水平与身体质量指数（BMI）、腰臀比、颈围、HOMA-IRI、呼吸暂停低通气指数（AHI）、血氧饱和度〈90％时间（Ts90％）、ESS评分、肿瘤坏死因子-α[（TNF-α）及白介素-6（IL-6）呈负相关（r=-0．233～-0．499，P〈0．05），而与夜间最低血氧饱和度（LSaO2）、Ⅲ＋Ⅳ期、快速眼动相睡眠占总睡眠时间百分比呈正相关（r=0．270～0．429，P〈0．05）。结论OSAHS患者存在血浆脂联素水平的下降及胰岛素抵抗，脂联素水平下降的相关危险因素可能包括肥胖、缺氧、睡眠结构的紊乱及其他脂肪因子的影响等。

Objective To investigate the changes of serum adiponectin level and insulin resistance in patients with obstructive sleep apnea hypopnea syndrome （OSAHS）. Methods 80 adult habitual snorers were divided into mild, moderate, severe OSAHS groups and control group, based on their apnea hypopnea index （AHI）. Correlative clinical data were measured and analyzed. Results Serum adiponectin level [ （ 5.44 ± 2. 57 ） mg/L ] was significantly lower and HOMA-insulin resistance index （ 3.42 ± 0. 70 ） was significantly higher in severe group than other groups （ P 〈 0. 05 ）. Serum adiponectin level was negatively correlated with BMI, waist hip ratio, neck circumferences and et al（ r = -0. 233 - -0. 499, P 〈0. 05）, but it was positively correlated With lowest oxygen saturation （LSaO2）, Ⅲ ＋ Ⅳ% and REM% （ r =0. 270 - 0. 429, P 〈 0. 05）. Conclusions Both hypoadiponectinemia and insulin resistance were observed in severe OSAHS patients. The related risk factors of hypoadiponectinemia in OSAHS might include obesity, disordered sleep architecture and other adipokines.