阻塞性睡眠呼吸暂停低通气综合征患者IGF-1、OPG、RANKL及骨密度变化

Changes of IGF-1,OPG,RANKL and BMD in patients with obstructive sleep apnea hypopnea syndrome

目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者胰岛素样生长因子1(IGF-1)、骨保护素(OPG)、核因子κB受体活化因子配体(RANKL)和骨密度的变化。方法根据病情严重程度,将45例OSAHS男性患者分为轻度OSAHS组(A1组,15例)、中度OSAHS组(A2组,15例)和重度OSAHS组(A3组,15例);另选取健康人群15例作为对照(B组)。检测各组BMI、睡眠呼吸暂停低通气指数(AHI)、最低动脉血氧饱和度(SaO2)、骨密度以及血清钙、磷、ALP、IGF-1、OPG、RANKL水平,并观察持续性气道正压通气(CPAP)对中、重度OSAHS患者的治疗效果。结果 BMI、AHI和RANKL水平在A3、A2、A1、B组中依次减少(P<0.05),而最低SaO2、骨密度、IGF-1、OPG和OPG/RANKL在B、A1、A2、A3组中依次减少(P<0.05)。AHI与BMI、RANKL呈正相关(r=0.405、0.305,P<0.05),而与ALP、IGF-1、OPG、OPG/RANKL、最低SaO2、腰椎和左侧股骨颈骨密度呈负相关(r=-0.162、-0.296、-0.253、-0.505、-0.807、-0.289和-0.277,P<0.05)。与治疗前相比,A2、A3组患者经CPAP治疗后AHI和RANKL水平降低,最低SaO2、骨密度、IGF-1、OPG和OPG/RANKL增加(P<0.05)。结论 OSAHS患者有骨质疏松患病风险,这与IGF-1水平和OPG/RANKL比例有关。CPAP能改善OSAHS患者AHI,提高骨密度,预防和治疗骨质疏松。

Objective To investigate the changes of serum insulin-like growth factor 1(IGF-1),osteoprotegerin(OPG),receptor activator of NF-κB ligand(RANKL) and bone mineral density(BMD) in the patients with obstructive sleep apnea hypopnea syndrome(OSAHS).MethodsAccording to the severity of illness,45 male patients with OSAHS were divided into three groups of A1(with mild OSAHS,15 cases),A2(with moderate OSAHS,15 cases) and A3(with severe OSAHS,15 cases).Another 15 healthy male people were taken as the controls(group B).BMI,apnea hypopnea index(AHI),lowest arterial oxygen saturation(SaO2),BMD and serum levels of calcium,phosphorus,ALP,IGF-1,OPG and RANKL were detected.The efficacy of continuous positive airway pressure(CPAP) in the treatment of patients with moderate and severe OSAHS was observed.ResultsThe increase in BMI,AHI and RANKL was in an order of group A3>group A2>group A1>group B(P<0.05).The increase in the lowest SaO2,BMD,IGF-1,OPG and OPG/RANKL was in an order of group B>group A1>group A2>group A3(P<0.05).AHI was positively correlated with BMI and RANKL(r=0.405 and 0.305,P<0.05),but was negatively correlated to ALP,IGF-1,OPG,OPG/RANKL,lowest SaO2,BMD of lumbar vertebra and femoral neck(r=-0.162,-0.296,-0.253,-0.505,-0.807,-0.289 and-0.277,P<0.05).Compared with before,AHI and RANKL were decreased,while the lowest SaO2,BMD,IGF-1,OPG and OPG/RANKL were increased after CPAP treatment in groups of A2 and A3(P<0.05).Conclusion The patients with OSAHS have a higher risk for osteoporosis,which may be related to IGF-1 and ratio of OPG/RANKL.CPAP could improve AHI,increase BMD and prevent osteoporosis in the patients with OSAHS.