2型糖尿病睡眠障碍患者动态血压节律与胰岛α细胞功能的关系

Relationship between ambulatory blood pressure rhythm and islet α-cells function in patients with type 2 diabetes suffered from sleep disorders

目的探讨2型糖尿病睡眠障碍患者动态血压节律与胰岛α细胞功能的关系。方法应用匹兹堡睡眠质量指数（PSQI）将天津医科大学代谢病医院2012年1月至2014年7月收治的406例2型糖尿病患者分为无睡眠障碍组（242例）和睡眠障碍组（164例），均行口服葡萄糖耐量试验、胰岛素和胰高血糖素释放试验及24 h动态血压监测，比较两组空腹和糖负荷后胰岛α细胞功能、血压昼夜节律及其变异性等，对PSQI总分行相关分析，Logistic回归分析血压昼夜节律的影响因素。结果睡眠障碍组各时间点胰高血糖素和胰高血糖素/胰岛素比值、胰高血糖素曲线下面积及0、30、60、180 min胰高血糖素/血糖比值明显高于无睡眠障碍组（t=2.109~14.188，均P〈0.05）。睡眠障碍组24 h收缩压和舒张压、夜间收缩压和舒张压、白天收缩压均较无睡眠障碍组高[分别为（135±8）比（130±7）mmHg （1 mmHg=0.133 kPa）、（74±6）比（72±6） mmHg、（131±7）比（126±6） mmHg、（72±5）比（68±5） mmHg、（138±8）比（133±8） mmHg，t=2.254~8.432，均P〈0.05]。与无睡眠障碍组相比，睡眠障碍组夜间收缩压和舒张压下降百分率明显降低、24 h收缩压和舒张压标准差及变异系数明显增加（t=2.232~10.065，均P〈0.05）。Logistic回归分析显示血压昼夜节律与夜间收缩压下降百分率呈正相关（OR：2.014~3.006），与胰高血糖素曲线下面积（OR：0.652~0.975）、PSQI总分（OR：0.623~0.818）呈负相关（均P〈0.05）。结论2型糖尿病睡眠障碍患者动态血压节律可能与胰岛α细胞功能异常有关。

Objective To investigate the relationship between ambulatory blood pressure rhythm and islet α？cells function in patients with type 2 diabetes suffered from sleep disorder. Methods Four hundred and six patients with type 2 diabetes treated from January 2012 to July 2014 in Metabolic Disease Hospital of Tianjin Medical University were divided into two groups according to Pittsburgh Sleep Quality Index（PSQI）：patients without sleep disorder （242 cases） and patients with sleep disorder （164 cases）. Oral glucose tolerance test （OGTT）, insulin releasing test, glucagon releasing test and 24 h ambulatory blood pressure monitoring were performed in those patients. The differences of α？cells function after fasting and glucose？load, as well as the circadian rhythm of blood pressure and blood pressure variation were compared between the two groups. The correlation analysis was performed between PSQI score and other indicators, and Logistic regression analysis was performed between blood pressure circadian rhythm and influence indicators. Results The level of glucagon and glucagon/insulin ratio at each time point as well as area under curve of glucagon and 0, 30, 60, 180 min glucagon/glucose ratio were significantly higher in patientsnbsp;with sleep disorder than those in patients without sleep disorder（t=2.109-14.188, all P〈0.05）. The levels of 24 h systolic and diastolic blood pressure, nocturnal systolic and diastolic blood pressure and systolic blood pressure of daytime were all significantly higher in diabetic patients with sleep disorder than those in patients without sleep disorder（（135 ± 8） vs （130 ± 7） mmHg（1 mmHg=0.133 kPa）, （74 ± 6） vs （72 ± 6） mmHg, （131 ± 7） vs （126 ± 6） mmHg, （72 ± 5） vs （68 ± 5） mmHg, （138 ± 8） vs （133 ± 8） mmHg, respectively, t=6.162, 2.254, 8.432, 5.940, 5.585, all P〈0.05）. The percentage of decreased systolic blood pressure at night and percentage of decreased diastolic blood pressure at night were lower, whereas 24 h systolic and diastolic blood pressure standard deviation as well as variation coefficient were higher in patients with sleep disorder those in patients without sleep disorder（t=2.232-10.065, all P〈0.05）. Logistic regression analysis showed that blood pressure circadian rhythm was positively related to the percentage of decreased systolic blood pressure at night（OR：2.014-3.006）, and negatively related to area under curve of glucagon （OR：0.652-0.975） and PSQI score （OR：0.623-0.818） （all P〈0.05）. Conclusion Circadian rhythm of blood pressure may be related to isletα？cells dysfunction in patients with type 2 diabetes suffered from sleep disorder.