手术对重度阻塞性睡眠呼吸暂停低通气综合征合并代谢综合征患者疗效分析

Analysis of the surgical efficacy for patients with severe obstructive sleep apnea hypopnea syndrome and metabolic syndrome

目的探讨手术治疗重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并代谢综合征(metabolic syndrome,MS)患者的临床疗效。方法 23例重度OSAHS合并MS患者行双侧扁桃体切除术和改良悬雍垂腭咽成形术。测定患者手术前后睡眠呼吸暂停低通气指数(AHI)、最低动脉血氧饱和度(LSaO_2)、体质量指数(BMI)、空腹血糖(FBG)、血脂、稳态模型胰岛素抵抗指数(homeostasis model assessment-insulin resistance index,HOMA-IR)、血压、腹围等各项指标,并比较前后变化。结果 (1)术后6个月,AHI、LSaO_2、收缩压、舒张压、FBG均有显著降低(t=7.461、-5.303、4.952、4.650、2.949,P均<0.01);BMI和HOMA-IR亦有改善趋势,但无统计学差异;高密度脂蛋白、甘油三酯(TG)和腹围无变化。(2)术前TG与腹围、HOMA-IR呈正相关(r=0.87、0.63,P均<0.05),FBG与LSaO2呈负相关(r=-0.79,P<0.05)。结论手术治疗可以改善OSAHS合并MS患者的AHI、LSaO_2等指标,同时也明显改善MS相关指标,有助于减少MS的发生和发展,有重要的临床意义。

OBJECTIVE To investigate the clinical efficacy of operation on patients with severe obstructive sleep apnea hypopnea syndrome（OSAHS） and metabolic syndrome（MS）. METHODS Twenty-three patients with severe OSAHS and MS were performed tonsillectomy and H-UPPP. Apnea hypopnea index（AHI）, lowest oxygen saturation（LSaO2）, body mass index（BMI）, fasting blood glucose（FBG）, blood lipid, homeostasis model assessmentinsulin resistance index（HOMA-IR）, blood pressure and abdominal circumference were recorded and compared before and after operation. RESULTS AHI, LSaO2,systolic blood pressure（SBP）, diastolic blood pressure（DBP）and FBG were reduced significantly at 6 months after operation（t =7.461,-5.303, 4.952, 4.650, 2.949, P 〈0.01）. There was a trend of improvement in BMI and HOMA-IR, but the difference was not significant. High density lipoprotein cholesterol（HDL-C）, triglyceride（TG） and abdominal circumference were unchanged. Preoperative TG was positively related to abdominal circumference and HOMAIR（r =0.87, 0.63, P 〈0.05）,and FBG was negatively related to LSaO2（r =-0.79, P 〈0.05）. CONCLUSION Operation can not only improve the AHI, LSaO2 in patients with severe OSAHS and MS, but also improve the related parameters of MS significantly. It can help to reduce the occurrence and development of MS and has important clinical significance.