持续气道正压通气联合药物对2型糖尿病伴阻塞性睡眠呼吸暂停低通气综合征患者的疗效观察

Efficacy of continuous positive airway pressure combined with medicine in treatment of type 2 diabetes mellitus patients with obstructive sleep apnea hypopnea syndrome

目的观察持续气道正压通气(CPAP)联合孟鲁司特钠、利拉鲁肽对2型糖尿病(T2DM)伴阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的临床疗效。方法将123例T2DM伴OSAHS患者随机分为对照组62例与观察组61例。对照组采用口服孟鲁司特钠和经皮注射利拉鲁肽治疗,观察组在对照组治疗基础上联合CPAP治疗。观察并比较2组患者治疗前后血清8-异前列腺素F2α(8-iso-PGF2α)、白细胞介素-6(IL-6)、CXC趋化因子配体13(CXCL13)水平和睡眠呼吸参数、认知能力、睡眠质量、OSAHS严重程度。结果治疗后,观察组呼吸暂停低通气指数(AHI)、最长呼吸暂停时间、最低脉搏容积血氧饱和度依次为(10.41±2.58)次/h、(41.07±5.69)s、(88.09±6.58)%,分别低于、短于、高于对照组的(14.29±2.62)次/h、(50.98±3.15)s、(72.36±4.26)%,差异有统计学意义(P<0.05)。治疗后,观察组血清8-iso-PGF2α、IL-6、CXCL13水平依次为(103.57±23.58)、(20.54±4.21)、(68.29±14.59)pg/mL,分别低于对照组的(245.29±15.36)、(26.38±3.01)、(92.47±10.22)pg/mL,差异有统计学意义(P<0.05)。治疗后,观察组OSAHS严重程度低于对照组,差异有统计学意义(P<0.05)。治疗后,观察组认知能力评分、睡眠质量评分依次为(23.61±3.29)、(0.38±0.08)分,分别高于、低于对照组的(20.87±1.16)、(1.42±0.22)分,差异有统计学意义(P<0.05)。结论CPAP联合孟鲁司特钠、利拉鲁肽治疗T2DM伴OSAHS患者能显著降低血清8-iso-PGF2α、IL-6、CXCL13水平,改善睡眠质量,减轻疾病严重程度,促进认知功能恢复。

Objective To observe the clinical efficacy of continuous positive airway pressure(CPAP)combined with montelukast and liraglutide in the treatment of type 2 diabetes mellitus(T2 DM)patients with obstructive sleep apnea-hypopnea syndrome(OSAHS).Methods A total of 123 T2 DM patients complicating OSAHS were randomly divided into control group(n=62)and observation group(n=61).The control group was orally taken montelukast sodium and percutaneous injection of liraglutide,and the observation group received CPAP on the basis of the control group.The serum levels of 8-iso-prostaglandin F2α(8-iso-PGF2α),interleukin-6(IL-6),CXC-chemokine ligand 13(CXCL13),sleep breathing parameters,cognitive ability,sleep quality and OSAHS severity were observed and compared between the two groups before and after treatment.Results After treatment,the apnea hypopnea index(AHI),longest apnea time and lowest pulse volume oxygen saturation in the observation group were(10.41±2.58)times/h,(41.07±5.69)s and(88.09±6.58)%,respectively,which were lower,shorter or higher than(14.29±2.62)times/h,(50.98±3.15)s and(72.36±4.26)%,respectively of the control group(P<0.05).After treatment,the serum levels of 8-isoPGF2α,IL-6 and CXCL13 in the observation group were(103.57±23.58),(20.54±4.21)and(68.29±14.59)pg/m L,respectively,which were lower than(245.29±15.36),(26.38±3.01)and(92.47±10.22)pg/m L,respectively,in the control group(P<0.05).After treatment,OSAHS severity in the observation group was lower than that in the control group(P<0.05).After treatment,the cognitive ability scored(23.61±3.29)in the observation group,which was higher than(20.87±1.16)in the control group,and sleep quality scored(0.38±0.08)in the observation group,which was lower than(1.42±0.22)in the control group(P<0.05).Conclusion CPAP combined with montelukast sodium and liraglutide can significantly reduce serum levels of 8-iso-PGF2α,IL-6 and CXCL13,improve sleep quality,relieve disease severity and promote recovery of cognitive function in T2DM patients with OSAHS.