阻塞性睡眠呼吸暂停低通气综合征患者胰岛素抵抗与骨密度的关系

Relationship between insulin resistance and bone mineral density in obstructive sleep apnea hypopnea syndrome patients

目的观察不同程度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患者骨密度变化及其与胰岛素抵抗的关系。方法根据呼吸暂停低通气指数(apnea hypopnea index,AHI)将OSAHS患者分为:轻度(AHI 5~20次/h)、中度(AHI 21~40次/h)、重度(AHI>40次/h),测定以上3组及正常对照组的骨密度、骨代谢多个参数,血脂、空腹血糖、胰岛素水平及计算胰岛素抵抗指数(homeostasis model assessment for insulin resistance,HOMA-IR),并进行组间比较及与AHI的相关性。结果重度OSAHS患者骨密度(BMD L1-4:0.79±0.07 g/cm^2,BMD neck:0.78±0.09 g/cm^2)明显低于轻度OSAHS患者(BMD L1-4:0.95±0.12 g/cm^2,BMD neck:0.90±0.08 g/cm^2)及正常对照组(BMD L1-4:0.98±0.10 g/cm^2,BMD neck:0.91±0.11 g/cm^2),差异有统计学意义(P<0.05);但轻度OSAHS患者骨密度与正常对照组比较,差异无统计学意义(P>0.05)。OSAHS患者与正常对照(2.14±0.32)相比,及OSAHS不同程度3组(轻度、中度和重度OSAHS分别为2.53±0.29、3.34±0.35、3.98±0.31)间比较,HOMA-IR差异均有统计学意义(P<0.05);对于OSAHS患者,其胰岛素抵抗指数(HOMA-IR)与AHI呈正相关(r=0.398,P=0.000)。结论 OSAHS患者骨密度降低,易发生骨质疏松,且与缺氧程度及胰岛素抵抗密切相关。

Objective To explore the relationship between bone mineral density and insulin resistance in patients with obstructive sleep apnea hypopnea syndrome with different degrees. Methods According to the AHI （Apnea hypopnea index）, the OSAHS （Obstructive sleep apnea hypopnea syndrome） patients were divided into three groups： mild （AHI5-20 times/h）, moderate （AHI21-40times/h）, severe（AHI〉40 times/h）. To measure the bone mineral density, bone metabolism parameters, lipid, fasting blood glucose, fasting insulin level in OSAHS patients and normal control group, calculate insulin resistance index. At the same time, to analyze the correlation between bone metabolism parameters and AHI. Results The bone mineral density of patients with severe OSAHS （ BMD L1-4 ： 0.79 ± 0.07 g/cm^2, BMD neck ： 0.78 ± 0.09 g/cm^2 ） was significantly lower than that of mild OSAHS patients （ BMD L1-4 ： 0.95 ±0.12 g/cm^2, BMD neck： 0.90 ±0.08 g/cm^2） and normal control group （BMD L1-4：0.98 ±0.10 g/cm^2, BMD neck： 0.91 ±0.11 g/cm^2）, but there was no obvious difference between patients with mild OSAHS and normal control group. The difference of HOMA-IR was significant between patients and the normal control group （2.14 ± 0.32） , the difference was statistically significant too among OSAHS group （mild, moderate, and severe group： 2.55 ± 0.29, 5.34±0.35, and 3.98±0.31）,and the correlation between HOMA-IR and AHI was positive （r=0.398, P =0.000）. Conclusion The bone mineral density of OSAHS patients was decreased, and osteoporosis was easy to occur, which was closely related to the degree of hypoxia and insulin resistance.