阻塞性睡眠呼吸暂停低通气综合征合并2型糖尿病患者血清相关细胞因子变化的临床意义

The changes and significance of serum TNF-α,MCP-1,Nesfatin 1 in the obstructive sleep apnea hypopnea syndrome with type 2 diabetes

目的 观察血清肿瘤坏死因子-α(TNF-α),单核细胞趋化蛋白-1(MCP-1)、摄食抑制因子(Nesfatin-1)在阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并2型糖尿病(T2DM)患者中的变化及意义。方法选择2015年9月—2017年9月江苏省扬州大学附属医院接诊的单纯OSAHS患者50例(OSAHS组)、单纯T2DM患者50例(T2DM组)以及OSAHS合并T2DM患者50例(联合组)作为研究对象,并选择同期于医院体检中心接受体检的健康者50例为健康对照组。比较4组血清TNF-α、MCP-1,Nesfatin-1和空腹血糖(FPG)、睡眠呼吸暂停低通气指数(AHI)的水平,比较联合组接受经鼻持续气道正压通气(nCPAP)治疗前后血清TNF-α、MCP-1、Nesfatin-1及FPG、AHI的变化,分析血清TNF-α、MCP-1、Nesfatin-1在OSAHS合并T2DM中的意义。结果联合组血清TNF-α、MCP-1、Nesfatin-1和FPG、AHI均高于OSAHS组、T2DM组及健康对照组(P<0.01);治疗后,联合组血清TNF-α、MCP-1、Nesfatin-1及FPG、AHI较治疗前均显著降低(t=21.204、10.087、5.239、15.446、22.915,P<0.01);血清TNF-α、MCP-1、Nesfatin-1与FPG、AHI之间均呈正相关(r=0.475、0.389、0.517、0.397、0.412、0.452,P<0.01),血清TNF-α、MCP-1、Nesfatin-1均是OSAHS合并T2DM发病的独立危险因素(P<0.01)。联合检测血清TNF-α、MCP-1、Nesfatin-1曲线下面积(AUC)为0.958,特异度、准确度分别为92.04%、92.10%,均明显高于各指标单独检测结果(P<0.01)。结论在OSAHS合并T2DM患者中,血清TNF-α、MCP-1、Nesfatin-1的表达明显升高,与疾病的发生、发展之间密切相关。

Objective To study the changes and significance of serum tumor necrosis factora（ TNF-a）, monocyte chemoatlractant protein 1（MCP-1） and nesfatin 1 in the obstructive sleep apnea hypopnea syndrome（OSAHS） with type 2 diabetes（T2 DM）. Methods Fifty patients with simple,OSAHS, 50 patients with simple T2 DM, and 50 cases of OSAHS with T2 DM who received therapy from September 2015 to September 2017 in our hospital were selected, and 50 cases of healthy persons who received physical examination at the medical center of our hospital for the same period were selected as the control group. The expression of TNF-a, MCP-1, nesfatin 1, sleep apnea hypopnea index（AHI） and fasting blood glucose（FPG） between the four groups were compared, and the changes of serum TNF-a,MCP-I, nesfatin 1, AHI and FPG in the OSAHS with T2 DM group before and after received the treatment of nCPAP were compared, the significance of serum TNF-a,MCP-1 and nesfatin 1 in OSAHS combined with T2 DM was analyzed. Results The serum TNF-a, MCP-1, nesfatin 1 and FPG in the OSAHS with T2 DM group were significantly higher than those in the OSAHS group, T2 DM group and the control group, and the AHI and in the OSAHS with T2 DM group was significantly higher than those in group OSAHS group and T2 DM group, the differences were statistically significant（P〈0.05）; after treatment, the serum TNF-a, MCP-1, nesfatin 1, AHI and FPG in the OSAHS with T2 DM group were significantly lower than those before the treatment（t = 21.204, t = 10. 087, t =5. 239, t =22. 915,t =15. 446,P〈0. 05）; the results of Pearson correlation analysis showed that there was a positive correlation between serum TNF-α, MCP-1 nesfatin 1 and FPG and AHI（ r = 0. 475, r = 0. 389, r = 0. 517, r = 0. 397, r =0.412, r =0. 452,P〈0.05）; in the Logistic regression analysis, serum TNF-α, MCP-1,and nesfatin 1 are independent risk factors for the pathogenesis of OSAHS with T2 DM（P〈0.05）; and combined detection of serum TNF-α, MCP-1 and nesfatin1＇s under the curve area was 0.958,95% CI was 0.910 ～0.984%,specificity and accuracy were 92.04% and 92.10%,respectively, which were significantly higher than those of each index（P〈0.05）. Conclusion In patients with OSAHS with T2 DM,the expression of serum TNF-α, MCP-1 and nesfatin 1 were significantly increased, which is closely related to the occurrence and development of disease.