2型糖尿病患者视网膜病变与睡眠障碍的关系

Association between retinopathy and sleep disorder in patients with type 2 diabetes mellitus

目的 研究2型糖尿病患者视网膜病变与睡眠障碍的关系.方法 应用匹兹堡睡眠质量指数将2011年7月至2013年7月于天津医科大学代谢病医院治疗的440例2型糖尿病患者分为无睡眠障碍组（258例）和睡眠障碍组（182例）,测定肝肾功能、血脂、糖化血红蛋白（HbA1c）、果糖胺、血液流变学等生化指标,行口服葡萄糖耐量试验及胰岛素、胰高血糖素释放试验,比较两组空腹和糖负荷后胰岛α和β细胞功能变化,对视网膜病变影响因素行logistic回归分析.本研究经天津医科大学伦理委员会审查批准.结果 睡眠障碍组视网膜病变患病比例为42.9％ （78/182）,高于无睡眠障碍组的32.6％（84/258）,差异有统计学意义（P =0.027）.睡眠障碍组空腹静脉血糖、餐后2h血糖、HbA1c、果糖胺、收缩压、舒张压、血浆黏度、红细胞聚集指数、红细胞刚性指数、纤维蛋白原均高于无睡眠障碍组,红细胞变形指数低于无睡眠障碍组（均P＜0.05）.睡眠障碍组各时间点胰高血糖素水平、胰高血糖素/胰岛素比值及胰高血糖素曲线下面积明显高于无睡眠障碍组（均P＜0.05）.睡眠障碍组空腹胰岛素、稳态模型-胰岛素抵抗指数、胰岛素曲线下面积高于无睡眠障碍组,胰岛素敏感指数低于无睡眠障碍组（均P ＜0.05）.多因素logistic回归分析显示视网膜病变与HbA1c（OR：1.744～3.249）、纤维蛋白原（OR：1.687～2.998）、收缩压（OR：1.152 ～2.013）、稳态模型-胰岛素抵抗指数（OR：1.006～1.389）、睡眠障碍呈正相关（OR：1.144 ～2.426）,与胰岛素敏感指数呈负相关（OR：0.107～0.784）,均P＜0.05.结论 改善睡眠障碍可能有助于延缓糖尿病视网膜病变的发生发展.

Objective To explore the association between retinopathy and sleep disorder in patients with type 2 diabetes mellitus （T2DM）.Methods A total of 440 patients with T2DM treated from July 2011 to July 2013 in Metabolic Disease Hospital of Tianjin Medical University were divided into 2 groups according to Pittsburgh Sleep Quality Index：non-sleep disorder group （258 cases） and sleep disorder group （182 cases）.Biochemical parameters including hepatorenal function,blood lipids,glycosylated hemoglobin （HbA1c）,fructosamine and hemorrheology were detected.Oral glucose tolerance test,insulin releasing test and glucagon releasing test were performed to detect the inter-group differences of α-cell and β-cell function after fasting and glucose-load management.The logistic regression analysis was performed to identify the factors relevant to retinopathy.Results The ratio of retinopathy was 42.9% in sleep disorder group,which was higher compared to those in non-sleep disorder group （32.6%）,P =0.027.The levels of fasting plasma glucose,postprandial blood glucose,HbA1 c,fructosamine,systolic blood pressure,diastolic blood pressure and the indicators of hemorrheology （plasma viscosity,erythrocyte aggregation index,erythrocyte rigidity index,fibrinogen） were significantly higher in patients with sleep disorder compared to those without sleep disorder,while the erythrocyte defomation index was significantly lower in sleep disorder group （all P 〈 0.05）.The levels of glucagon and glucagon/insulin ratio at each time point as well as area under curve of glucagon were significantly higher in sleep disorder group （all P 〈 0.05）.The levels of fasting insulin,homeostasis model assessment for insulin resistance index （HOMA-IR） and area under curve of insulin were significantly higher in patients with sleep disorder compared to those without sleep disorder,while insulin sensitivity index was lower in patients with sleep disorder（all P 〈 0.05）.Logistic regression analysis showed that retinopathy was positively related to HbA1 c （OR：1.744-3.249）,fibrinogen （OR：1.687-2.998）,systolic blood pressure（OR：1.152-2.013）,HOMA-IR （OR：1.006-1.389） and sleep disorder（OR：1.144-2.426）,and negatively related to insulin sensitivity index（OR：0.107-0.784） （all P 〈0.05）.Conclusion Sleep disorders may be associated with retinopathy through multiple mechanisms in patients with T2DM.