阻塞性睡眠呼吸暂停综合征对老年COPD患者糖脂代谢的影响

Research on the impact of obstructive sleep apnea syndrome on blood glucose and lipid metabolism in patients with chronic obstructive pulmonary disease

目的探讨老年慢性阻塞性肺疾病(COPD)合并阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)患者的血糖和血脂代谢的水平及意义。方法选取2011年1月—2015年12月间杭州市第三人民医院呼吸内科住院确诊为COPD的患者100人,其中包括COPD合并OSAS组45例(轻度OSAS组15例,中度OSAS组18例,重度OSAS组12例),无合并OSAS患者55例。对比分析COPD组和COPD合并OSAS组患者血脂及血糖水平,并分析其与呼吸暂停低通气指数(apnea-hypopnea index,AHI)的相关性,进而探讨OSAS对老年COPD的影响。结果 COPD合并OSAS组患者的BMI(身体质量指数)、LDL(低密度脂蛋白)水平均明显高于COPD组,而COPD合并OSAS组患者的HDL(高密度脂蛋白)水平显著低于COPD组,差异均有统计学意义(P<0.05)。FPG(空腹血糖)、胰岛素抵抗指数(homeostasis model assessment of insulin resistance,HOMA-IR)、HbA1C(糖化血红蛋白)、LDL、AHI在OSAS轻、中、重各组间差异有统计学意义(P<0.05)。另外,COPD合并OSAS患者的AHI和BMI、LDL、FPG、HOMA-IR呈显著性正相关(P<0.05)。结论 OSAS增加了COPD患者血脂水平和糖尿病的风险,可能与增加胰岛素抵抗和LDL水平有关。

Objective To investigate the blood glucose and lipid metabolism levels in elderly chronic obstructive pulmonary disease（COPD） patients with obstructive sleep apnea syndrome（OSAS） and the significance. Methods One hundred cases of COPD patients in respiratory department of our hospital from January,2011 to December,2015 were select- ed,including 45 cases in COPD with OSAS group（mild OSAS 15 cases,moderate OSAS 18 cases,severe OSAS 12 cases） ,and 55 cases in COPD without OSAS group. The blood lipids and blood glucose levels of COPD group and COPD with OSAS group were compared, and their correlation with AHI was analyzed to investigate the effect of obstructive sleep apnea syndrome on chronic obstructive pulmonary disease. Results The BMI and LDL levels of COPD with OSAS group were significantly higher than that of COPD group, and HDL level of COPD with OSAS group was significantly lower than that of COPD group, all with statistically significant differences （ P 〈 0.05 ）. The differences in FPG, HOMA-IR, HbA1 C, LDL, AHI levels of mild OSAS ,moderate OSAS, severe OSAS were statistically significant（ P 〈 0.05 ）. And the AHI level of OSAS patients was significantly in positive correlation to BMI, LDL, FPG, HOMA-IR levels （ P 〈 0.05 ）. Conclusion OSAS increased the risk of high blood lipids and diabetes of COPD patients,which might be associated with the increasing of insulin resistance and LDL levels.