阻塞性睡眠呼吸暂停综合征合并非酒精性脂肪性肝病危险因素分析

Analysis of risk factors of obstructive sleep apnea syndrome combine with nonalcoholic fatty liver disease

目的阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAHS)与非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)在临床中常常合并存在,但其内在机制尚未明确。本研究旨在探讨OSAHS合并NAFLD发病的危险因素。方法选择福建医科大学附属龙岩第一医院2016-06-01-2018-12-31收治的符合标准258例OSAHS患者为研究对象。对所有患者行多导睡眠监测(polysomnography,PSG)检查,根据呼吸暂停低通气指数(apnea hypopnea index,AHI)分为轻、中和重度OSAHS。所有患者空腹抽出静脉血检测血脂水平,同时均行腹部超声检查,根据超声结果分为病例组(OSAHS合并NAFLD,n=153)和对照组(OSAHS未合并NAFLD,n=105),记录患者体质量指数(body mass index,BMI)、AHI、最低氧饱和度(lowest oxygen saturation,L-SaO2)、三酰甘油(triglyceride,TG)及总胆固醇(total cholesterol,TC)、低密度脂蛋白胆固醇(low density lipoprotein bile steroid,LDL-C)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)水平,并进行数据分析。结果病例组患者重度OSAHS比例69.70%,高于对照组的30.30%,差异有统计学意义,χ2=7.192,P=0.007。病例组患者AHI、BMI、TC、TG和LDL-C水平高于对照组,差异均有统计学意义,均P<0.05;HDL-C水平低于对照组,差异有统计学意义,P<0.05。Logistic回归分析结果显示,BMI(OR=1.819,95%CI为1.072~3.088)、TC(OR=2.411,95%CI为1.377~4.222)、HDL(OR=0.434,95%CI为0.250~0.753)和AHI(OR=3.141,95%CI为1.826~5.404)为OSAHS伴NAFLD发病的危险因素。结论 BMI增大、TC升高、HDL降低及AHI升高是OSAHS合并NAFLD发病的危险因素,减轻体质量,控制胆固醇及三酰甘油水平,可能有效预防NAFLD的发生。

OBJECTIVE Obstructive sleep apnea syndrome(OSAHS)and non-alcoholic fatty liver disease(NAFLD) are often combined in clinical,but the underlying mechanism is not very clear.The purpose of this study was to explore the risk factors of the onset of NAFLD combined with OSAHS.METHODS A total of 258 cases of OSAHS patients were selected to conform to the standard.All patients were monitored by polysomnography(PSG)and were divided into mild,moderate and severe OSAHS groups according to the apnea hypopnea index(AHI).All patients were treated with blood lipid,and the liver B ultrasound examination was performed at the same time.According to the results of ultrasound,patients were divided into the case group(OSAHS with NAFLD)and the control group(OSAHS without NAFLD).The body mass index(BMI),AHI,the lowest oxygen saturation(L-SaO2),triglyceride(TG),total cholesterol(TC),low density lipoprotein bile Steroid(LDL-C)and high-density lipoprotein cholesterol(HDL-C)levels were recorded and analyzed.RESULTS The proportion of severe OSAHS in the case group was higher than that in the control group(69.70%vs 30.30%,χ2=7.192,P=0.007).The levels of AHI,BMI,TC,TG and LDL-C in the case group were significantly higher than those in the control group(all P<0.05).The level of HDL-C in the case group was significantly lower than that in the control group(P<0.05).The Logistic analysis showed that BMI(OR=1.819,95%CI:1.072-3.088),TC(OR=2.411,95%CI:1.377-4.222),HDL(OR=0.434,95%CI:0.250-0.753)and AHI(OR=3.141,95%CI:1.826-5.404)were risk factors for OSAHS associated with NAFLD.CONCLUSIONS BMI,TC,HDL and AHI are risk factors for OSAHS associated with NAFLD.Reducing body mass and controlling cholesterol and triglyceride levels may effectively prevent the occurrence of NAFLD.