发作性睡病伴肥胖患儿的临床特征

Clinical features of obese children with narcolepsy

目的：分析发作性睡病伴肥胖患儿的临床特征，探讨肥胖对发作性睡病患儿的影响。方法选取2012年7月至2015年1月首都儿科研究所附属儿童医院神经内科首次确诊的发作性睡病患儿40例，参照中国儿童体质量指数（BMI）生长曲线中关于肥胖的诊断标准分为伴肥胖及不伴肥胖2组。对2组患儿的一般临床资料进行分析，并对2组患儿肥胖的相关代谢指标、整夜多导睡眠监测（PSG）情况进行对比研究。结果本组患儿男女比例3：1，伴肥胖组21例（52.5％），不伴肥胖组19例（47.5％）。所有患儿 BMI 为（21.55±3.11）kg/ m2。伴肥胖组 BMI（23.09±2.46）kg/ m2，不伴肥胖组 BMI（19.85±2.89）kg/ m2。伴肥胖组患儿发病年龄及就诊年龄[（7.94±2.22）岁、（8.76±2.36）岁]均低于不伴肥胖组患儿[（10.75±3.10）岁、（12.51±2.88）岁]。所有患儿空腹血糖及血脂三项均未见异常，组间比较差异无统计学意义。伴肥胖组患儿睡眠总时间、睡眠效率及快速眼球运动（REM）期比率[（397.45±53.76）min、（68.70±8.90）％、（18.37±4.39）％]均明显低于不伴肥胖组[（449.95±86.49）min、（76.58±13.60）％、（22.19±6.34）％]。从睡眠结构来看，伴肥胖组患儿的非快速眼球运动（NREM）Ⅰ期占（20.90±6.38）％，较不伴肥胖组[（16.26±4.22）％]增加，Ⅱ期所占比率在伴肥胖组[（42.59±5.52）％]与不伴肥胖组[（38.54±8.74）％]之间未见明显差异。Ⅲ＋Ⅳ期（慢波睡眠期）比率伴肥胖组[（18.14±6.97）％]明显低于不伴肥胖组[（22.60±5.69）％]。结论肥胖症是发作性睡病常见的共患病之一，影响了50％以上的患儿，容易出现在低年龄段的发作性睡病患儿中。伴肥胖的睡病患儿夜间睡眠总时间减少，睡眠效率降低，睡眠结构紊乱更加明显。提高对发作性睡病伴肥胖患儿的认识，及早合理用药是成功治疗的关键。

Objective To analyze the clinical characteristics of narcolepsy in children with obesity,and to e-valuate the impact of obesity on narcoleptic children clinically. Methods Forty cases first diagnosed as narcolepsy were recruited in the study who to see doctors at the Department of Neurology,Children＆#39;s Hospital of Capital Institute of Pediatrics,from July 2012 to January 2015. According to diagnostic criteria for obesity by the body mass index（BMI） growth curve for the Chinese children and adolescents,they were divided into the obese group and the nonobese group. The general clinical data of 2 groups were analyzed,and the related metabolic indexes and the whole night polysomnog-raphy（PSG）of 2 groups were studied. Results In this group,male versus female 3： 1,obesity was found in 21 cases （52. 5% ）and nonobesity was found in 19 cases（47. 5% ）from the samples. The mean BMI of all patients was （21. 55 ± 3. 11）kg/ m2 . The average BMI of the obese group was（23. 09 ± 2. 46）kg/ m2 ,and BMI of the non - obese group was（19. 85 ± 2. 89）kg/ m2 . Obese children were younger at the onset of disease and by the time of diagnosis age [（7. 94 ± 2. 22）years old,（8. 76 ± 2. 36）years old]than nonobese children[（10. 75 ± 3. 10）years old,（12. 51 ± 2. 88）years old]. The fasting blood glucose and blood lipid in all patients were normal,and there was no significant difference between 2 groups. The total sleep time,sleep efficiency and the ratio of rapid eye movement（REM）phase of the obese group[（397. 45 ± 53. 76）min,（68. 70 ± 8. 90）% ,（18. 37 ± 4. 39）% ]were significantly lower than those of the non - obese group[（449. 95 ± 86. 49）min,（76. 58 ± 13. 60）% ,（22. 19 ± 6. 34）% ]. According to the sleep structure,the percentage of stageⅠnon rapid eye movement（NREM）sleep in the obese group[（20. 90 ± 6. 38）% ] was more than that in non - obese group[（16. 26 ± 4. 22）% ]. There was no difference between the percentage of stageⅡNREM sleep in the obese group[（42. 59 ± 5. 52）% ]and the non - obese group[（38. 54 ± 8. 74）% ]. Stage Ⅲ ＋ Ⅳ（slow wave sleep）NREM sleep ratio in the obese group[（18. 14 ± 6. 97）% ]was significantly lower than that in the non - obese group[（22. 60 ± 5. 69）% ]. Conclusions Obesity is one of the most common comorbids in narcolepsy, which affects more than 50% of narcoleptic children,mostly younger at disease onset. The narcolepsy children with obe-sity has total sleep time decreased,sleep efficiency reduced and sleep structure disorder is more obvious. To improve the realization of obesity in narcolepsy children and early treatment is the key to the success of the therapy.