中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2009年
10期
1018-1020
,共3页
王强%樊利萍%王蓓%刘卓拉%陈晓阳
王彊%樊利萍%王蓓%劉卓拉%陳曉暘
왕강%번리평%왕배%류탁랍%진효양
睡眠呼吸暂停低通气综合征%胰岛素抵抗%抵抗素%脂联素
睡眠呼吸暫停低通氣綜閤徵%胰島素牴抗%牴抗素%脂聯素
수면호흡잠정저통기종합정%이도소저항%저항소%지련소
Obstructive sleep apnea-hypopnea syndrome%Insulin resistance%Resistin%Adiponectin
目的 探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血浆抵抗素和脂联素水平与胰岛素抵抗程度的相关性.方法 根据整夜多导睡眠监测(PSG)和既往病史将68例OSAHS患者分为轻度(24例)、中度(13例)、重度(31例)OSAHS组,并设正常对照组(20例).检测各组空腹血糖、胰岛素、血脂、抵抗素、脂联素水平,计算稳态模型胰岛素抵抗指数(HOMA-IR),并分析HOMA-IR与抵抗素、脂联素、血脂、体重指数、腰臀比、睡眠呼吸暂停低通气指数(AHI)、最低血氧饱和度(LSaO2)、夜间血氧饱和度低于90%的时间占总睡眠时间的百分比(T90)等指标的相关性.结果 轻、中、重度OSAHS组的抵抗素水平[分别为(8.04±2.14)、(10.85±4.89)、(13.34±3.52)mg/L]均明显高于正常对照组[(5.14±1.94)mg/L]差异均有统计学意义(P均<0.05),且OSAHS重度组明显高于轻度组(P<0.05).脂联素在OSAHS轻度[(6.21±1.74)mg/L]、中度[(4.19±1.80)mg/L]、重度[(2.26±1.17)mg/L]组的水平均明显低于正常对照组[(9.49±2.40)mg/L],且OSAHS各组间差异均有统计学意义(P均<0.05).OSAHS中、重度组的HO-MA-IR(4.07±0.97、5.61±2.26)明显高于OSAHS轻度组(1.57±0.58)和正常对照组(2.47±1.52),且OS-AHS中、重度组间差异也有统计学意义(P均<0.05).Spearman相关分析显示HOMA-IR与抵抗素、总胆固醇、甘油三酯、体重指数、腰臀比、AHI、190有显著正相关(r值分别为0.794、0.438、0.430、0.351、0.456、0.775、0.624,P均<0.01),与脂联素、LSaO2有显著负相关(r值为-0.563、-0.623,P均<0.01).偏相关分析显示控制脂联素和抵抗素影响后,HOMA-IR与190、AHI有显著正相关(r值分别为0.231、0.358,P均<0.05).多元逐步回归分析显示AHI和抵抗素为影响HOMA-IR的最显著因素(R2=0.613,F=69.810,P<0.01).结论 OSAHS患者的HOMA-IR与OSAHS严重程度具有显著正相关,且独立于血脂、体重指数、腰臀比、抵抗素和脂联素等因素的影响;血脂、体重指数、腰臀比等因素可能通过对抵抗素和脂联素的作用影响HOMA-IR;AHI和血浆抵抗素水平可能成为判断OSAHS患者胰岛素抵抗水平的重要生物学标志.
目的 探討阻塞性睡眠呼吸暫停低通氣綜閤徵(OSAHS)患者血漿牴抗素和脂聯素水平與胰島素牴抗程度的相關性.方法 根據整夜多導睡眠鑑測(PSG)和既往病史將68例OSAHS患者分為輕度(24例)、中度(13例)、重度(31例)OSAHS組,併設正常對照組(20例).檢測各組空腹血糖、胰島素、血脂、牴抗素、脂聯素水平,計算穩態模型胰島素牴抗指數(HOMA-IR),併分析HOMA-IR與牴抗素、脂聯素、血脂、體重指數、腰臀比、睡眠呼吸暫停低通氣指數(AHI)、最低血氧飽和度(LSaO2)、夜間血氧飽和度低于90%的時間佔總睡眠時間的百分比(T90)等指標的相關性.結果 輕、中、重度OSAHS組的牴抗素水平[分彆為(8.04±2.14)、(10.85±4.89)、(13.34±3.52)mg/L]均明顯高于正常對照組[(5.14±1.94)mg/L]差異均有統計學意義(P均<0.05),且OSAHS重度組明顯高于輕度組(P<0.05).脂聯素在OSAHS輕度[(6.21±1.74)mg/L]、中度[(4.19±1.80)mg/L]、重度[(2.26±1.17)mg/L]組的水平均明顯低于正常對照組[(9.49±2.40)mg/L],且OSAHS各組間差異均有統計學意義(P均<0.05).OSAHS中、重度組的HO-MA-IR(4.07±0.97、5.61±2.26)明顯高于OSAHS輕度組(1.57±0.58)和正常對照組(2.47±1.52),且OS-AHS中、重度組間差異也有統計學意義(P均<0.05).Spearman相關分析顯示HOMA-IR與牴抗素、總膽固醇、甘油三酯、體重指數、腰臀比、AHI、190有顯著正相關(r值分彆為0.794、0.438、0.430、0.351、0.456、0.775、0.624,P均<0.01),與脂聯素、LSaO2有顯著負相關(r值為-0.563、-0.623,P均<0.01).偏相關分析顯示控製脂聯素和牴抗素影響後,HOMA-IR與190、AHI有顯著正相關(r值分彆為0.231、0.358,P均<0.05).多元逐步迴歸分析顯示AHI和牴抗素為影響HOMA-IR的最顯著因素(R2=0.613,F=69.810,P<0.01).結論 OSAHS患者的HOMA-IR與OSAHS嚴重程度具有顯著正相關,且獨立于血脂、體重指數、腰臀比、牴抗素和脂聯素等因素的影響;血脂、體重指數、腰臀比等因素可能通過對牴抗素和脂聯素的作用影響HOMA-IR;AHI和血漿牴抗素水平可能成為判斷OSAHS患者胰島素牴抗水平的重要生物學標誌.
목적 탐토조새성수면호흡잠정저통기종합정(OSAHS)환자혈장저항소화지련소수평여이도소저항정도적상관성.방법 근거정야다도수면감측(PSG)화기왕병사장68례OSAHS환자분위경도(24례)、중도(13례)、중도(31례)OSAHS조,병설정상대조조(20례).검측각조공복혈당、이도소、혈지、저항소、지련소수평,계산은태모형이도소저항지수(HOMA-IR),병분석HOMA-IR여저항소、지련소、혈지、체중지수、요둔비、수면호흡잠정저통기지수(AHI)、최저혈양포화도(LSaO2)、야간혈양포화도저우90%적시간점총수면시간적백분비(T90)등지표적상관성.결과 경、중、중도OSAHS조적저항소수평[분별위(8.04±2.14)、(10.85±4.89)、(13.34±3.52)mg/L]균명현고우정상대조조[(5.14±1.94)mg/L]차이균유통계학의의(P균<0.05),차OSAHS중도조명현고우경도조(P<0.05).지련소재OSAHS경도[(6.21±1.74)mg/L]、중도[(4.19±1.80)mg/L]、중도[(2.26±1.17)mg/L]조적수평균명현저우정상대조조[(9.49±2.40)mg/L],차OSAHS각조간차이균유통계학의의(P균<0.05).OSAHS중、중도조적HO-MA-IR(4.07±0.97、5.61±2.26)명현고우OSAHS경도조(1.57±0.58)화정상대조조(2.47±1.52),차OS-AHS중、중도조간차이야유통계학의의(P균<0.05).Spearman상관분석현시HOMA-IR여저항소、총담고순、감유삼지、체중지수、요둔비、AHI、190유현저정상관(r치분별위0.794、0.438、0.430、0.351、0.456、0.775、0.624,P균<0.01),여지련소、LSaO2유현저부상관(r치위-0.563、-0.623,P균<0.01).편상관분석현시공제지련소화저항소영향후,HOMA-IR여190、AHI유현저정상관(r치분별위0.231、0.358,P균<0.05).다원축보회귀분석현시AHI화저항소위영향HOMA-IR적최현저인소(R2=0.613,F=69.810,P<0.01).결론 OSAHS환자적HOMA-IR여OSAHS엄중정도구유현저정상관,차독립우혈지、체중지수、요둔비、저항소화지련소등인소적영향;혈지、체중지수、요둔비등인소가능통과대저항소화지련소적작용영향HOMA-IR;AHI화혈장저항소수평가능성위판단OSAHS환자이도소저항수평적중요생물학표지.
Objective To explore relationship between resistin'adipenectin and insulin resistance(IR) in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods Based on polysomnography (PSG) and disease history ,68 patients were divided into three groups: mild ( L, n = 24 ), moderate ( M, n = 13 ), severe ( S, n = 31 ) OSAHS, and normal control ( n = 20 ). Fasting serum glucose, insulin, lipoids, resistin and adipanectin were measured. HOMA-IR was calculated, the correlation between HOMA-IR and resistin, adiponectin, lipoids, body mass index, waist-to-hip ratio, apnea-hypopnea index ( AHI), the lowest saturation of blood oxygen ( LSaO2) and the per-centage of total sleep time spent with an oxygen saturation less than 90% (T90) were analysed. Results The levels of serum resistins in each OSAHS group were (8.04 ±2. 14), ( 10.85±4.89 ), ( 13.34±3.52 )mg/L, and were sig-nificantly higher than those in control group ( 9.49 ± 2.40) mg/L ( P < 0.05 ), S were significantly higher than L (P<0.05) ;The levels of serum adiponectin of OSAHS groups were(6. 21 ± 1.74), (4. 19±1.80), (2.26± 1.17 ) mg/L, and were significantly lower than those in control group(9.49±2.40) mg/L (P < 0.05 ), and the inter-group differences were statistically significant (P <0. 05). HOMA-IR of M and S were(4.07±0.97), (5.61± 2.26) significantly higher than those of L and control group( 1.57 ±0. 58 ), (2.47 ±1.52 ) ( P < 0.05 ), and inter-group differences between M and S were statistical significant( P < 0.05 ). Spearman correlation analysis showed that HOMA-IR was significantly positive correlated with resistin, total cholesterol, triglyceride, body mass index,waist-hip rafio,AHI,T90( r =0. 794,0.438,0. 430,0. 351,0. 456,0.775,0.624 ,P <0.01 ) ,negative with adiponectin, LSaO2 (r=-0.563, -0.623 ,P <0.01 ). Partial correlation analysis showed that after the effect of adiponeetin and resis-tin were controlled,HOMA-IR was significant positive correlation with T90 and AHI(r =0.231,0.358 ,P <0.05 ). Multiple stepwise regression analysis showed that, to HOMA-IR, resistin and AHI were the most significant impact factors (R2 =0.613,F=69.810,P<0.01). Conclusions HOMA-IR is significantly positively correlated with the severity of OSAHS,independent of the blood lipids, body mass index, waist-hip ratio, resistin, adiponectin and other factors;the effects of blood lipids,body mass index,waist-hip ratio and other factors on HOMA-IR probably depend on resistin and adiponectin;AHI and plasma resistin level may determine the level of insulin resistance in patients with OSAHS.
