糖尿病并阻塞性睡眠呼吸暂停综合征与TNF-α、PAI的相关性研究

Association of OSAS in patients with type 2 diabetes with levels of tumor necrosis factor-oz and plasminogen activator inhibitor

目的探讨合并阻塞性睡眠呼吸暂停综合征（obstructivesleepapneasyndrome，OSAS）的2型糖尿病患者的肿瘤坏死因子d（tumornecrosisfactor-α，TNF-α）、凝血酶原激活物抑制物（plasminogenactivatorinhibitor．PAI）变化情况，并探讨其与睡眠中低氧血症发病的相关性。方法病例组为住院的2型糖尿病患者共54例，分为伴有OSAS者（O组）27例和不伴有OSAS者（N组）27例。对照组（C组）来自于同期体检且无内分泌疾病及OSAS的患者（n=26）。ELISA分析3组血清TNF-α、PAI的水平。多导睡眠初筛仪监测睡眠呼吸紊乱指数（AHI）、夜间最低脉搏血氧饱和度（LSpO2）等指标。并探讨TNF-α、PAI与稳态模型评估的胰岛素抵抗指数（HOMA—IR）、空腹血糖、睡眠呼吸紊乱指数（AHI）、夜间最低脉搏血氧饱和度（LSpO2）、年龄相关性。分别以TNF-α、PAI为因变量，以空腹血糖、HOMA-IR、AHI、LSpO2、年龄为自变量进行多元逐步直线回归分析。结果O组的HOMA-IR、TNF-α、PAI[分别为2．69±1．53、（1．97±0．13）ng／ml和（2．27±0．85）ng／m1]均高于其余2组，且N组的这3项指标[分别为1．70±0．88、（1．09±0．29）ng／ml和（1．59±0．13）ng／m1]均高于C组『分别为1．15±0．67、（0．73±0．19）ng／ml和（0．89±0．25）ng／m1]。2组糖尿病的空腹血糖高于C组。O组的AHI高于N组及C组，夜间LSpO，低于N组及C组。单因素Spearman相关分析显示TNF-α、PAI均与HOMA—IR、空腹血糖、AHI呈正相关，与夜间LSpO，呈负相关。多元逐步直线回归分析显示影响TNF-α的因素依次是AHI、空腹血糖；影响PAI的因素依次是AHI、HOMA—IR。结论合并OSAS的2型糖尿病患者的慢性低活度炎症状态更加严重，干预OSAS可能有助于2型糖尿病慢性并发症的防治。

Objective To investigate the changes in tumor necrosis factor-α （TNF-α） and plasminogen activator inhibitor（PAl） in the presence of obstructive sleep apnea syndrome （OSAS） in patients with type 2 diabetes mellitus, and to investigate if that 2 inflammatory factors is associated with hypoxemia during sleep. Methods Fifty- four patients with type 2 diabetes mellitus hospitalized for giycemic control were subgrouped into 27 patients with OSAS （ group O） and 27 patients without OSAS （ group N）. 26 people without diabetes and OSAS were selected from a health check-up program to serve as control group （ group C ）. Serum TNF-α and PAI levels were measured by commercial ELISA kits. Apnea hypopnea index （AHI） , the lowest pulse oxygen saturation （ LSpO2 ） at night were detected by portable sleep monitor. The relativity regarding TNF-α, PAI, homeostasis model assessment for insulin resistance （HOMA-IR） , fasting blood glucose（FBG） , AHI, LSpO2, and age was discussed. TNF-α and PAI were regard as dependent variables, and FBC, HOMA-IR, AHI, LSpO2 , and age as independent variables in multivariate stepwise linear analysis. Results The levels of HOMA-IR , TNF--α, PAIingroupOI2.69_±l.53,（1.97~0.13）ng/ml, and （2.27 ± 0.85 ） ng/ml ] were higher than the those in other 2 groups, and those in group N [ 1.70 ± 0.88, （ 1.09 ± 0.29 ） ng/ml, and （ 1.59 ± 0.13 ） ng/ml ] were higher than group C 1 1.15 ± 0.67, （ 0.73 ± 0.19 ） ng/ml, and （ 0.89 ± 0.25 ） ng/ml ] . The levels of FBG in the 2 diabetic groups were higher than those in group C. The level of AHI in group O was higher than that in group N and group C, while LSpO2 in group O was lower than that in group N and group C. Spearman univariate analysis showed that TNF-α and PAI both were associated positively with HOMA-IR, FBG, and AHI, while negatively with LSpO2. Multivariate stepwise linear analysis denoted that TNF-α was independently associated with AHI, FBG, while PAI was independently associated with AHI and HOMA-IR. Conclusions Patients with diabetes and OSAS manifest raised level of chronic inflammatory activity, and therefore, OSAS might be implicated in the pathogenesis of chronic complication of patients with type 2 diabetes.