nCPAP治疗对合并中重度OSAHS的2型糖尿病患者胰岛素抵抗及瘦素水平的影响

Effects of nCPAP treatment on insulin resistance and serum leptin in patients with type 2 diabetes and moderate and severe obstructive sleep apnea-hypopnea syndrome

目的:探讨长期nCPAP治疗对合并中重度OSAHS的2型DM患者胰岛素抵抗及血清瘦素(leptin)水平的影响。方法:选取多导睡眠监测(PSG)确诊的中重度OSAHS伴2型DM患者且对nCPAP治疗依从性好者50例进行6个月的nCPAP,治疗前后检测其FGB、HbA1c、胰岛素敏感性指标及血清leptin水平,采用配对t检验进行比较、评价。结果:(1)nCPAP治疗后受试者FGB[(7.5±1.8)mmol/L]、HbA1c[(7.0±1.4)%]和leptin水平[(9.6±5.2)ng/ml]较治疗前FGB[(9.7±2.2)mmol/L]、HbA1c[(8.6±2.0)%]和leptin[(14.9±8.8)ng/ml]显著降低(t=9.348,P<0.001;t=10.598,P<0.001;t=6.086,P<0.001);(2)治疗后胰岛素抵抗(IR)的稳态模式评估指数(HOMA-IR)(2.4±1.1)显著降低(t=3.140,P<0.01)。结论:nCPAP可改善合并中重度OSAHS的2型DM患者的血糖控制,降低瘦素水平,增加其胰岛素敏感性。

Objective：To investigate the effects of nasal continuous positive airway pressure（nCPAP） treatment for long time on insulin resistance and serum leptin in patients with moderate and severe obstructive sleep apnea-hypopnea syndrome（OSAHS）and type 2 diabetes.Methods： To use 6 months of nCPAP treatment on 50 patients,who can receive the treatment without contraindication,with type 2 diabetes and newly diagnosed OSAHS.The level of FGB,glycohemoglobin（HbAlc）,insulin and serum leptin were measured and compared to the data previously obtained.Results： After the application of nCPAP treatment,the patients＇ concentration of FGB [（7.5±1.8） mmol/L],HbAlc [（7.0±1.4）%] and leptin[（9.6±5.2） ng/ml]were lower than those previous obtainedt=9.348,P0.001;t=10.598,P0.001;t=6.086,P0.001].And the homeostasis model assessment（HOMA） index of insulin resistance（2.4±1.1） was significantly lower compared with that obtained before the nCPAP treatment（t=3.140,P0.001）.Conclusion： For the patients with moderate and severe OSAHS and type 2 diabetes,nCPAP treatment can improve the control of the level of FGB,HbAlc,leptin and promote the insulin sensitivity.