阻塞性睡眠呼吸暂停低通气综合征与胰岛素抵抗、血脂及C反应蛋白的关系研究

Study of relationship of obstructive sleep apnea hypopnea syndrome with insulin resistance,blood lipid metabolism and C-reactive protein

目的探讨阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)对患者的胰岛素抵抗、血脂及炎症反应的影响。方法根据多导睡眠图(PSG)检测结果将60例符合OSAHS诊断的受试对象分为轻中度OSAHS组、重度OSAHS组,同时选取40例作为正常对照组。测量每位受试对象的身高、体质量,计算体质量指数(BMI),比较3组受试对象的睡眠状况及睡眠中末梢血氧变化,抽取患者的空腹血行生化指标检查及空腹胰岛素、血糖及C反应蛋白检测并进行比较。结果 OSAHS组睡眠中末梢平均血氧及最低血氧均较对照组下降(P<0.01),呼吸暂停低通气指数(AHI)较对照组升高(P<0.01),且与OSAHS严重程度相关。OSAHS组三酰甘油、低密度脂蛋白胆固醇、载脂蛋白B、BMI、胰岛素抵抗指数均较对照组明显升高(P<0.05),且与OSAHS严重程度相关。相反,OSAHS组高密度脂蛋白胆固醇、载脂蛋白A较对照组下降,且重度OSAHS组下降显著(P<0.05)。OSAHS组外周血CRP较对照组升高(P<0.05),且与OSAHS严重程度相关(P<0.05)。结论OSAHS影响机体的胰岛素抵抗、血脂代谢,炎症反应参与其中。

Objective To explore the effects of obstructive sleep apnea hypopnea syndrome（ OSAHS） on body insulin resistance,blood lipid metabolism and inflammatory reaction. Methods According to the level of apnea hypoventilation index（ AHI）,60 subjects diagnosed with OSAHS by polysomnography（ PSG） test were divided into mildto-moderate OSAHS group and severe OSAHS group,and 40 subjects without OSAHS were selected as control group. Body height and weight of all subjects were tested to calculate body mass index（ BMI）. The sleep patterns and peripheral blood oxygen during sleeping of two groups were compared. Fasting blood was collected for the detection of biochemical indexes,fasting insulin,fasting blood glucose and c-reactive protein（ CRP）. Results The average level and the lowest level of blood oxygen of OSAHS patients were significantly lower than those of control group,and the decline degree of blood oxygen of OSAHS patients was significantly related with OSAHS severity（ P 〈 0. 01）. AHI of OSAHS patients was significantly higher than that of control group（ P 〈 0. 01）,and the increase degree of AHI was significantly related with OSAHS severity.The levels of triglyceride（ TG）,low density lipoprotein（ LDL）,apolipoprotein B（ apo B）,body mass index（ BMI） and insulin resistance（ IR） of OSAHS patients were higher than those of control group, and the increase degree was significantly related with OSAHS severity（ P 〈 0. 05）. Conversely,the levels of high density lipoprotein（ HDL）,apolipoprotein A（ apo A） of OSAHS patients were significantly lower than those of control group,especially,in the severe OSAHS group. Peripheral blood CRP level of OSAHS patients was higher than that of the control goup（ P 〈 0. 05）,and the degree of increase was significantly related with OSAHS severity（ P 〈 0. 05）. Conclusions OSAHS induces the body’s insulin resistance and blood lipid metabolism disorder,at the same time inflammation plays a certain role.