CAJ | 학술논문

目的探讨合并阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)的2型糖尿病患者的肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)、凝血酶原激活物抑制物(plasminogen activator inhibitor,PAI)变化情况,并探讨其与睡眠中低氧血症发病的相关性.方法病例组为住院的2型糖尿病患者共54例,分为伴有OSAS者(O组)27例和不伴有OSAS者(N组)27例.对照组(C组)来自于同期体检且无内分泌疾病及OSAS的患者(n=26).ELISA分析3组血清TNF-α、PAI的水平.多导睡眠初筛仪监测睡眠呼吸紊乱指数(AHI)、夜间最低脉搏血氧饱和度(LSpO2)等指标.并探讨TNF-α、PAI与稳态模型评估的胰岛素抵抗指数(HOMA-IR)、空腹血糖、睡眠呼吸紊乱指数(AHI)、夜间最低脉搏血氧饱和度(LSpO2)、年龄相关性.分别以TNF-α、PAI为因变量,以空腹血糖、HOMA-IR、AHI、LSpO2、年龄为自变量进行多元逐步直线回归分析.结果 O组的HOMA-IR、TNF-α、PAI[分别为2.69±1.53、(1.97±0.13) ng/ml和(2.27±0.85) ng/ml]均高于其余2组,且N组的这3项指标[分别为1.70 ±0.88、(1.09±0.29) ng/ml和(1.59±0.13) ng/ml]均高于C组[分别为1.15±0.67 、(0.73±0.19) ng/ml和(0.89±0.25) ng/ml].2组糖尿病的空腹血糖高于C组.O组的AHI高于N组及C组,夜间LSpO2低于N组及C组.单因素Spearman相关分析显示TNF-α、PAI均与HOMA-IR、空腹血糖、AHI呈正相关,与夜间LSpO2呈负相关.多元逐步直线回归分析显示影响TNF-α的因素依次是AHI、空腹血糖；影响PAI的因素依次是AHI、HOMA-IR.结论合并OSAS的2型糖尿病患者的慢性低活度炎症状态更加严重,干预OSAS可能有助于2型糖尿病慢性并发症的防治.
목적 탐토합병조새성수면호흡잠정종합정(obstructive sleep apnea syndrome,OSAS)적2형당뇨병환자적종류배사인자α(tumor necrosis factor-α,TNF-α)、응혈매원격활물억제물(plasminogen activator inhibitor,PAI)변화정황,병탐토기여수면중저양혈증발병적상관성.방법 병례조위주원적2형당뇨병환자공54례,분위반유OSAS자(O조)27례화불반유OSAS자(N조)27례.대조조(C조)래자우동기체검차무내분비질병급OSAS적환자(n=26).ELISA분석3조혈청TNF-α、PAI적수평.다도수면초사의감측수면호흡문란지수(AHI)、야간최저맥박혈양포화도(LSpO2)등지표.병탐토TNF-α、PAI여은태모형평고적이도소저항지수(HOMA-IR)、공복혈당、수면호흡문란지수(AHI)、야간최저맥박혈양포화도(LSpO2)、년령상관성.분별이TNF-α、PAI위인변량,이공복혈당、HOMA-IR、AHI、LSpO2、년령위자변량진행다원축보직선회귀분석.결과 O조적HOMA-IR、TNF-α、PAI[분별위2.69±1.53、(1.97±0.13) ng/ml화(2.27±0.85) ng/ml]균고우기여2조,차N조적저3항지표[분별위1.70 ±0.88、(1.09±0.29) ng/ml화(1.59±0.13) ng/ml]균고우C조[분별위1.15±0.67 、(0.73±0.19) ng/ml화(0.89±0.25) ng/ml].2조당뇨병적공복혈당고우C조.O조적AHI고우N조급C조,야간LSpO2저우N조급C조.단인소Spearman상관분석현시TNF-α、PAI균여HOMA-IR、공복혈당、AHI정정상관,여야간LSpO2정부상관.다원축보직선회귀분석현시영향TNF-α적인소의차시AHI、공복혈당；영향PAI적인소의차시AHI、HOMA-IR.결론 합병OSAS적2형당뇨병환자적만성저활도염증상태경가엄중,간예OSAS가능유조우2형당뇨병만성병발증적방치.
Objective To investigate the changes in tumor necrosis factor-α(TNF-α) and plasminogen activator inhibitor(PAI) in the presence of obstructive sleep apnea syndrome(OSAS) in patients with type 2 diabetes mellitus,and to investigate if that 2 inflammatory factors is associated with hypoxemia during sleep.Methods Fiftyfour patients with type 2 diabetes mellitus hospitalized for glycemic control were subgrouped into 27 patients with OSAS (group O) and 27 patients without OSAS (group N).26 people without diabetes and OSAS were selected from a health check-up program to serve as control group (group C).Serum TNF-α and PAI levels were measured by commercial ELISA kits.Apnea hypopnea index (AHI),the lowest pulse oxygen saturation (LSpO2) at night were detected by portable sleep monitor.The relativity regarding TNF-α,PAI,homeostasis model assessment for insulin resistance (HOMA-IR),fasting blood glucose(FBG),AHI,LSpO2,and age was discussed.TNF-α and PAI were regard as dependent variables,and FBG,HOMA-IR,AHI,LSpO2,and age as independent variables in multivariate stepwise linear analysis.Results The levels of HOMA-IR,TNF-α,PAI in group O [2.69 ± 1.53,(1.97 ±0.13) ng/ml,and (2.27 ± 0.85) ng/ml] were higher than the those in other 2 groups,and those in group N [1.70 ± 0.88,(1.09 ±0.29) ng/ml,and (1.59 ± 0.13) ng/ml] were higher than group C [1.15 ± 0.67,(0.73 ± 0.19) ng/ml,and (0.89 ±0.25) ng/ml].The levels of FBG in the 2 diabetic groups were higher than those in group C.The level of AHI in group O was higher than that in group N and group C,while LSpO2 in group O was lower than that in group N and group C.Spearman univariate analysis showed that TNF-α and PAl both were associated positively with HOMA-IR,FBG,and AHI,while negatively with LSpO2.Multivariate stepwise linear analysis denoted that TNF-α was independently associated with AHI,FBG,while PAI was independently associated with AHI and HOMA-IR.Conclusions Patients with diabetes and OSAS manifest raised level of chronic inflammatory activity,and therefore,OSAS might be implicated in the pathogenesis of chronic complication of patients with type 2 diabetes.