持续气道正压通气治疗对2型糖尿病合并阻塞性睡眠呼吸暂停低通气综合征患者血清视黄醇结合蛋白4和脂联素的影响

Effect of CPAP treatment on serum retinol binding protein 4 and adiponectin in T2DM patients complicated with OSAHS

目的探讨T2DM合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者在持续正压通气治疗(CPAP)前后血清视黄醇结合蛋白4(RBP4)及APN的变化规律。方法选取2014年6月至2016年10月于上海交通大学医学院附属同仁医院内分泌科、呼吸内科住院的T2DM合并OSAHS患者155例,随机分为CPAP治疗组(CPAP)73例和常规治疗对照组(Con)77例,测定治疗前、后12周呼吸参数变化,以及治疗前、治疗后4周、8周、12周的血清RBP4、APN、FPG、FIns,计算胰岛素抵抗指数(HOMAIR)。结果 CPAP组各项呼吸参数改善,血清APN升高程度高于Con组,4周、8周及12周分别为(7.92±3.15)vs(6.87±3.06)mg/L,(8.99±5.46)vs(7.15±3.20)mg/L,(11.68±4.65)vs(8.34±3.25)mg/L(F_(交互)=13.980,P=0.000),其升高程度随着治疗时间增加而增加(F_(时间)=26.574,P=0.000);血清RBP4降低程度低于Con组,4周、8周、12周分别为(22.10±2.82)vs(23.84±3.51)μg/L,(19.52±3.02)vs(22.98±4.07)μg/L,(16.43±2.56)vs(20.15±3.24)μg/L(F_(交互)=11.057,P=0.000),其降低幅度随着治疗时间增加而减少(F_(时间)=23.056,P=0.000)。结论 CPAP治疗能有效纠正T2DM合并OSAHS患者的低氧血症,改善IR,而RBP4和APN可作为监测病情转归、判断预后的有效指标。

Objective To investigate the change of serum retinol-binding protein 4 （RBP4） and serum adiponectin（APN）in patients with type 2 diabetes mellitus（T2DM）combined with obstructive sleep apnea-hypopnea syndrome （OSAHS）after continuous positive airway pressure （CPAP）treatment. Methods 150 inpatients from Shanghai Tongren Hospital（Jun 2014 to Oct 2016）were randomly divided into CPAP group （ CPAP, n=73 ） and the control group （ Con, n = 77 ）. Sleep-breathing parameters were collected before and after 12 weeks of treatment. Serum RBP4, APN, fast blood glucose and fast insulin were detected in 4 weeks, 8 weeks and 12 weeks after treatment, HOMA insulin resistance index（HOMA- IR） was calculated. Results Compared with Con group, the sleep-breathing parameters improved significantly. Serum APN levels at different treatment points were significantly higher in CPAP group than Con group,respectively （7.92±3.15） vs （6.87±3.06）mg/L,（8.99±5.46） vs （7.15±3.20）mg/L,（11.68±4.65） vs （8.34 ± 3.25 ） mg/L （Fi = 13. 980, P = 0. 000）, and gradually increased when the treatment continued（F=26. 574,P=0. 000）. Serum RBP4 levels were significantly lower in CPAP group than Con group,respectively （22.10±2.82） vs （23. 84±3. 51）gg/L, （19. 52±3. 02） vs （22. 98±4. 07） μg/ L,（16. 434±2.56）vs （20. 15±3.24）μg/L （Fi = 11. 057, P= 0. 000）, and gradually decreased When the treatment continued（Ft = 23. 056, P = 0. 000）. Conclusion CPAP effectively improves the hypoxemia and insulin resistance in T2DM patients combined with OSAHS. The levels of serum RBP4 and APN are potential parameters to monitor the disease progression and prognosis.