阻塞性睡眠呼吸暂停综合征对肥胖患者非酒精性脂肪性肝病严重程度的影响

Effect of obstructive sleep apnea syndrome on the severity of nonalcoholic fatty liver disease in patients with obesity

目的探究阻塞性睡眠呼吸暂停综合征(OSA)对肥胖患者非酒精性脂肪肝病(NAFLD)严重程度的影响。方法选取自2019年10月至2021年2月南京大学医学院附属鼓楼医院内分泌科住院并经肝脏穿刺活检诊断NAFLD的肥胖患者144例(OSA组,70例;非OSA组74例)。比较两组血清肝酶、肝脏病理结果等,并分析其影响结果。结果与非OSA组相比,OSA组转氨酶、小叶炎症严重程度、NAFLD活动性评分更高(P均<0.05),非酒精性脂肪性肝炎(NASH)患病比例更高(P<0.05)。相关分析显示,NAFLD活动性评分与呼吸暂停低通气指数(AHI)、氧减指数(ODI)呈正相关,与平均血氧饱和度(SaO2)、最低SaO2呈负相关;肝脂肪变与AHI、ODI呈正相关;气球样变与AHI、ODI呈正相关;小叶炎症与AHI、ODI呈正相关,与平均SaO2、最低SaO2呈负相关。多因素logistic回归分析显示,OSA是NASH的独立危险因素(OR=8.397,95%CI:2.504~28.160)。结论OSA引起的慢性间歇性缺氧是肥胖患者NASH发病的重要危险因素。

Objective To explore the influence of obstructive sleep apnea syndrome(OSA)on the severity of nonalcoholic fatty liver disease(NAFLD)in obese patients.Methods A total of 144 obese patients(OSA group,70 cases;non-OSA group,74 cases)who were hospitalized in the Department of Endocrinology,Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School and biopsy-proven NAFLD from October 2019 to February 2021 were enrolled in this study.The serum liver enzymes and liver pathology of the two groups were compared,and the influence results were analyzed.Results Compared with the non-OSA group,the OSA group had higher serum levels of liver enzymes,severity of lobular inflammation,and NAFLD activity score(all P<0.05),and a higher prevalence of nonalcoholic steatohepatitis(NASH)(P<0.05).The results showed that NAFLD activity score was positively correlated with apnea-hypopnea index(AHI)and oxygen desaturation index(ODI),and negatively correlated with mean and minimum oxygen saturation(SaO2);hepatic steatosis was also positively associated with AHI and ODI;so was between the hepatocytes ballooning and AHI and ODI;the lobular inflammation was positively correlated with AHI and ODI,but negatively correlated with mean and lowest SaO2.Multivariate logistic regression analysis showed that OSA was an independent risk factor for NASH(OR=8.397,95%CI:2.504~28.160).Conclusion Chronic intermittent hypoxia caused by OSA is a crucial risk factor for NASH in obese patients.