睡眠呼吸暂停低通气综合征对2型糖尿病患者非酒精性脂肪肝的影响

Study on the impact of obstructive sleep apnea-hypopnea syndrome on nonalcoholic fatty liver disease in type 2 diabetes mellitus

目的 探讨2型糖尿病（T2DM）合并睡眠呼吸暂停低通气综合征（OSA）患者非酒精性脂肪肝（NAFLD）发生的可能机制.方法 选取单纯2型糖尿病患者113例（DM组）,2型糖尿病合并OSA患者124例（DO组）,比较各组一般临床资料、OSA相关指标、代谢指标及NAFLD患病比例的差异,并进行相关分析.另外根据2型糖尿病是否合并NAFLD分为NAFLD组（183例）与非NAFLD组（54例）,观察两组的临床指标及OSA发生率的差异.结果 （1）DO组BMI、空腹C肽（FCP）、胰岛素抵抗指数（HOMA-C）、TC、TG、WBC、ALT、AST、GGT、UA及NAFLD的发生率明显高于DM组（P＜0.05）.（2）放入回归方程,多元逐步回归分析提示,BMI、FCP与睡眠呼吸暂停低通气指数（AHI）呈正相关（P＜0.05）.（3）NAFLD组的病程、HDL-C、最低血氧饱和度（LPO2）及平均血氧饱和度（MPO2）水平较非NAFLD低,BMI、SBP、FPG、FCP、HbA1c、HOMA-C、TG、TC/HDL-C、ALT、GGT、UA、AHI、氧减指数（ODI）水平及OSA发生率均显著高于非NAFLD组（P＜0.05）.（4） NAFLD患病危险因素Logistic分析提示,BMI、HOMA-C、AHI为NAFLD患病的危险因素（P＜0.05）.结论 OSA为NAFLD的危险因素,可增加T2DM患者罹患NAFLD的风险.

Objective To investigate the possible mechanism of the relationship between obstructive sleep apnea-hypopnea syndrome （OSA） and nonalcoholic fatty liver disease （NAFLD） in type 2 diabetes mellitus （T2DM） patients.Methods T2DM patients during hospitalized from 2012 to 2014 were retrospectively investigated.Total 212 T2DM patients hospitalized in Department of Endocrinology from 2012 to 2014 were divided into non-OSA simple T2DM group （DM group,n =113） and OSA combined T2DM group （DO group,n =124）.These people were also divided into T2DM combined with nonalcoholic fatty liver disease （NAFLD） （NAFLD group,n =183） and without （non-NAFLD group,n =54）.The general clinical and metabolism data and the prevalence of NAFLD were compared.The general clinical and OSA data,and metabolism data,and prevalence of OSA in the ones with and without NAFLD were compared.Further correlation analysis was carried out.Results （1）The body mass index （BMI）,fasting c-peptide （FCP）,insulin-resistance index （HOMA-C）,total cholesterol （TC）,triglyceride （TG）,white blood cell count （WBC）,glutamate pyruvate transaminase （ALT）,glutamic-oxalacetic transaminase （AST）,glutamyl transpeptidase （GGT）,uric acid （UA）,and the prevalence of NAFLD were higher in DO group than DM group （P 〈 0.05）.（2） Linear regression analyze showed BMI,and FCP had positive correlation with apnea hypopnea index （AHI）.（3） The patients in NAFLD group had lower level of disease time,high density lipoprotein cholesferol （HDL-C）,minimum oxyhemoglobin saturation （LPO2）,average oxyhemoglobin saturation （MPO2） and higher level of BMI,systolic pressure （SBP）,fasting blood glucose （FPG）,FCP,glycosylated hemoglobin （HbA1c）,HOMA-C,triacylglycerol （TG）,cholesterol/high density lipoprotein cholesferol （TC/HDL-C）,ALT,GGT,UA,AHI,oxygen decrease index （ODI） and prevalence of OSA than those without NAFLD （P 〈 0.05）.（4） Multivariable logistic regression analysis showed that BMI,HOMA-C,and AHI were the risk factors of NAFLD in type 2 diabetes mellitus patients.Conclusions OSA could make T2DM suffer more NAFLD.