糖基化终末产物对2型糖尿病患者睡眠障碍与心血管疾病关系的影响

Impact of advanced glycation end products on the association of sleep disorders and incident cardiovascular events in patients with type 2 diabetes

目的分析2型糖尿病患者睡眠障碍与心血管疾病（CVD）的关系，并且探讨糖基化终末产物（AGEs）在睡眠障碍影响心血管疾病患病过程中的作用。方法选取2型糖尿病患者586例，采用匹兹堡睡眠量表（PSQI）评估睡眠质量，根据量表评分将患者分为睡眠障碍组（PSQI评分≥7分，n=240）和非睡眠障碍组（PSQI评分<7分，n=346）。采用糖基化终末产物检测仪（DiagnOpyics）根据荧光光谱测量系统测量AGEs。以心血管疾病是否患病（是=1，否=0）为因变量，分别以PSQI评分、AGEs水平为自变量，校正心血管疾病患病的影响因素，建立Logistic回归分析模型分析PSQI评分和AGEs水平与心血管疾病的关系；并行PSQI评分与AGEs的多元线性回归分析。结果睡眠障碍组心血管疾病比例、AGEs和PSQI评分均高于非睡眠障碍组（均P＜0.05）。PSQI评分与心血管疾病患病呈正相关（rs=0.180，P＜0.05）,与AGEs水平呈正相关（r=0.549，P＜0.001）；AGEs水平与心血管疾病患病呈正相关（rs=0.265，P＜0.001）。多元线性回归分析结果显示，AGEs水平随着PSQI评分升高而升高（β=0.504）。Logistics回归分析结果显示，PSQI评分高（OR=1.063，95%CI：1.019~1.109）、AGEs水平高（OR=2.144，95%CI：1.430~3.214）是2型糖尿病患者患心血管疾病的危险因素。结论睡眠障碍是糖尿病患者患心血管疾病的危险因素，AGEs可能参与介导了这一过程。

Objective To analyze the relevance of sleep disorders in type 2 diabetes (T2D) patients with cardiovascular disease (CVD), and to explore the influence of advanced glycation end products (AGEs) in the pathogenetic process of sleep disorder in the morbidity of CVD. Methods A total of 586 T2D patients were recruited and their sleep qualities were evaluated by the Pittsburgh Sleep Quality Index (PSQI). Patients were divided into two groups according to PSQI score, one was sleep disorder group (PSQI score≥7,n=240) and the other was non-sleep disorder group (PSQI score<7,n=346). AGEs were measured by AGEs detector (DiagnOpyics) with fluorescence spectrum detecting method. Logistic regression analysis was performed to examine the associations of the sleep disorder, AGEs and CVD. We adjusted for major confounding factors expected to affect the morbidity of CVD. The CVD was input as dependent variables (Yes=1, NO=0) and sleep disorder, AGEs were respectively input as independent variables.Multiple linear regression models were used to examine the associations of AGEs and PSQI score. Results The morbidity of CVD,AGEs and PSQI score were significantly higher in sleep disorder group compared to those of non-sleep disorder group (P < 0.05).PSQI score was positively related to the morbidity of CVD (rs=0.180,P<0.05),PSQI score was positively related to AGEs (r=0.549,P<0.001), AGEs score was positively related to the morbidity of CVD (rs=0.265, P<0.001). Results of multiple linear regression showed that AGEs increases with the increase of PSQI score (β=0.504,P < 0.05). Logistic regression analysis showed the higher PSQI score (OR=1.063, 95%CI: 1.019-1.109, P=0.005) and elevated AGEs (OR=2.144, 95%CI: 1.430-3.214, P<0.001) were risk factors for CVD in T2D patients. Conclusion Sleep disorders are a risk factor for CVD in T2D patients, and which may be mediated by AGEs.