不同糖耐量的睡眠障碍患者胰岛功能血清白介素-6及超敏C反应蛋白的相关性研究

Studies on the Correlation between islet Function Serum Interleukin-6 and Hypersensitive C-reactive Protein in Patients with Sleep Disorders with Different Glucose Tolerances

目的:观察不同糖耐量睡眠障碍患者白介素-6(IL-6)、超敏C反应蛋白(hsCRP)水平的变化及胰岛功能情况,旨在探讨睡眠障碍与高胰岛素血症、胰岛素抵抗及炎症反应的相关性。方法:选取108例既往无糖尿病史的睡眠障碍患者,对照组为同期年龄相匹配的糖耐量正常且无睡眠障碍人群;所有患者均行口服葡萄糖耐量试验(OGTT)、胰岛素释放试验,测定hsCRP、IL-6及血脂指标,并行国际匹兹堡睡眠质量量表(PSQI)评定睡眠状况。根据口服葡萄糖耐量试验(OGTT)结果分为糖耐量正常(NGT)、糖调节受损(IGR)及糖尿病(DM)三组。结果:NGT组、IGR组、DM组PSQI中位数水平明显高于对照组(P<0.05)。DM组空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1c)中位数水平均高于NGT组、IGR组、对照组(P均<0.05);IGR组FPG中位数水平高于对照组(P<0.05)。IGR组2hPG中位数水平高于NGT组、对照组(P均<0.05)。DM组空腹胰岛素(FINS)中位数水平高于对照组(P<0.05);DM组2h胰岛素(2hIns)、胰岛素抵抗指数(HOMA-IR)中位水平高于NGT组、对照组(P<0.05);IGR组2hIns中位数水平高于NGT组、对照组(P<0.05)。DM组甘油三酯(TG)中位水平均高于NGT组、IGR组、对照组(P均<0.05);从NGT至IGR及DM过程中,hsCRP及IL6中位水平呈逐渐上升趋势,且NGT组、IGR组、DM组IL-6中位水平均高于对照组(P<0.05);IGR组、DM组hsCRP中位水平均高于NGT组、对照组(P<0.05)。采用Logistic相关分析显示睡眠障碍与2hPG[OR=1.277,95.0%置信区间(1.046,1.558)]、hsCRP[OR=3.203,95.0%置信区间(1.028,9.980)]呈正相关。结论:睡眠障碍与高胰岛素血症、胰岛素抵抗、糖代谢紊乱、炎症反应有关,改善睡眠障碍可能减轻炎症反应、改善患者胰岛功能,从而降低糖调节受损或糖尿病的发病风险。

Objective: To observe the changes of IL-6 and hsCRP levels and pancreatic islet function in patients with different glucose tolerance , sleep disorders, to explore the correlation between sleep disorders , hyperinsulinemia, insulin resistance and inflammatory responses. Methods: 108 patients with sleep disorders who had no previous history of diabetes were selected. All patients underwent OGTT and insulin release test, tested hsCRP, IL-6 and blood lipids, assessed their sleep status in parallel with the international Pittsburgh sleep quality scale (PSQI).The results of OGTT were divided into three groups: NGT, IGR and DM. Results: The median PSQI level of NGT group, IGR group and DM group was significantly higher than that of the control group (P < 0.05). The median levels of FPG, 2h PG and HbA1c in DM group were higher than those in NGT group, IGR group and control group (all P <0.05).The median FPG level of IGR group was higher than that of control group (P<0.05).The median PG level of IGR group at 2 h was higher than that of NGT group and control group (all P <0.05).The median FINS level of DM group was higher than that of control group (P<0.05).The median levels of 2 hours insulin and HOMA-IR (homeostasis model assessment of insulin resistance) in DM group were higher than those in NGT group and control group (P<0.05).The median level of 2hIns in IGR group was higher than that in NGT group and control group (P<0.05). The median TG level of DM group was higher than that of NGT group, IGR group and control group (all P <0.05);In the process from NGT to IGR and DM, the median levels of hsCRP and IL-6 gradually increased, and the median levels of IL-6 in the NGT group, IGR group and DM group were all higher than those in the control group (P< 0.05).The median hsCRP level of IGR group and DM group was higher than that of NGT group and control group (P< 0.05). Spearman correlation analysis showed that PSQI total score was positively correlated with IL-6, hsCRP, FPG, 2h PG, HbA1c, FINS, 2 hIns, HOMA-IR and waist circumference (P<0.05). Logistic correlation analysis showed that sleep disorders were positively correlated with 2hPG [OR=1.277, 95.0% confidence interval (1.046,1.558)] and hsCRP [OR=3.203, 95.0% confidence interval (1.028,9.980)]. Conclusion: Sleep disorders are associated with hyperinsulinemia, insulin resistance, glucose metabolism disorder, and inflammatory response. Improving sleep disorders may improve pancreatic islet function and reduce inflammatory response, thus reducing the risk of impaired glucose regulation or diabetes.