肠道菌群在阻塞性睡眠呼吸暂停低通气综合征患者中的变化及与外周血炎症因子和胰岛素抵抗的关系

Changes of intestinal flora in patients with obstructive sleep apnea hypopnea syndrome and its relationship with peripheral blood inflammatory factors and insulin resistance

目的:探究阻塞性睡眠呼吸暂停低通气综合征(Obstructive sleep apnea hypopnea syndrome,OSAHS)患者肠道菌群变化与外周血炎症因子及胰岛素抵抗的关系。方法:选取2019年10月至2021年10月期间于本院确诊的102例OSAHS患者作为研究对象的OSAHS组,选取同期体检的60例健康体检者作为研究对象的对照组。将OSAHS患者根据呼吸暂停低通气指数(Apnea hypopnea index,AHI)分为重度组(n=32)、中度组(n=34)和轻度组(n=36)。比较不同组别肠道菌群失调情况。分析OSAHS组患者的血清肿瘤坏死因子α(Tumor necrosis factor-α,TNF-α)、白细胞介素(Interleukin,IL)-6、IL-1、胰岛素抵抗水平及肠道菌群水平。分析OSAHS患者肠道菌群水平与外周血炎症因子及胰岛素抵抗的相关性。结果:OSAHS组乳酸杆菌、双歧杆菌均明显低于健康对照组(P<0.05),肠球菌及大肠杆菌明显高于健康对照组(P<0.05)。中度、重度组患者的血清IL-1、IL-6、TNF-α、肠球菌、大肠杆菌、空腹血糖、空腹胰岛素、胰岛素抵抗(Insulin resistance,IR)水平高于轻度组,乳酸杆菌、双歧杆菌水平高于轻度组(P<0.05)。重度组血清TNF-α、IL-6、IL-1、空腹血糖、空腹胰岛素、IR、肠球菌、大肠杆菌水平高于中度组,乳酸杆菌、双歧杆菌水平低于中度组(P<0.05)。肠球菌、大肠杆菌与血清TNF-α、IL-6水平、IL-1、IR指数呈正相关(P<0.05),双歧杆菌、乳酸杆菌与血清TNF-α、IL-6、IL-1水平、IR指数呈负相关(P<0.05)。结论:肠道菌群在OSAHS患者中失调,且与胰岛素抵抗及外周血炎症因子水平关系密切。

Objective:To explore the relationship between intestinal flora and peripheral blood inflammatory factors and insulin resistance in patients with obstructive sleep apnea hypopnea syndrome(OSAHS).Methods:One hundred and two patients diagnosed with OSAHS in our hospital from October 2019 to October 2021 were selected as the study objects and included in the OSAHS group.At the same time,sixty healthy subjects in the same period were included in the control group.102 OSAHS patients were grouped according to apnea hypopnea index(AHI),and the patients were divided into severe group(n=32).Moderate group(n=34)and mild group(n=36).Compare the imbalance of gut microbiota in different groups.Analyze the serum levels of tumor necrosis factor-α(TNF-α),interleukin(IL)-6,IL-1,insulin resistance,and gut microbiota in patients with OSAHS.Analysis of the correlation between gut microbiota levels and peripheral blood inflammatory factors and insulin resistance in OSAHS patients.Results:Lactobacillus and bifidobacterium in OSAHS group were significantly lower than those in healthy control group(P<0.05),enterococcus and Escherichia coli were significantly higher than those in healthy control group(P<0.05).The serum levels of IL-1,IL-6,tumor necrosis factor-α(TNF-α,enterococci,Escherichia coli,fasting blood glucose,fasting insulin,and insulin resistance(IR)were higher in the moderate and severe groups than in the mild group,and the levels of lactobacilli and bifidobacteria were higher in the mild group than in the mild group(P<0.05).The levels of TNF-α,IL-6,IL-1,fasting blood glucose,fasting insulin,insulin resistance,enterococci,and Escherichia coli in the severe group were higher than those in the moderate group,while the levels of lactobacilli and bifidobacteria were lower than those in the moderate group(P<0.05)..Enterococcus and Escherichia coli were positively correlated with serum TNF-α,IL-6,IL-1 and IR levels(P<0.05),while bifidobacterium and Lactobacillus were negatively correlated with serum TNF-α,IL-6,IL-1 and IR levels(P<0.05).Conclusion:Intestinal flora is dysregulated in patients with OSAHS,which is closely related to insulin resistance and the level of peripheral blood inflammatory factors.