CAJ | 학술논문

目的评估2型糖尿病（T2DM）患者中阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的患病状况，并分析其影响因素，探讨是否与脑组织神经介质水平存在关联。方法连续收集2012年9月至2014年9月于上海市东方医院内分泌科住院的T2DM患者328例，其中男182例，女146例，平均年龄（63±13）岁。使用便携式睡眠呼吸监测仪评估睡眠呼吸暂停低通气指数（AHI），将患者分为单纯T2DM组125例，T2DM合并OSAHS组203例。对其中132例患者采用脑质子磁共振波谱法检测左侧海马区和左侧脑干区脑组织神经介质水平。组间均数比较采用独立样本t检验，率的比较采用χ2检验。结果 T2DM患者中OSAHS患病率61.9%（203/328例）。与非OSAHS组比较，OSAHS组患者在年龄、体质指数、腰围、臀围、左侧海马区的胆碱/肌酸（Cho/Cr）和左侧脑干区的胆碱/N?乙酰天门冬氨酸(Cho/NAA)水平和高血压患病率等差异均有统计学意义（t=-2.038、-3.391、-2.577、-2.576，Z=-1.923、-2.06，χ2=5.746，均P<0.05）。糖尿病病程、体质指数、高血压患病率在轻度和中重度OSAHS组之间存在明显差异（t=-2.074、-3.923，χ2=4.524，均P<0.05）。Logistic回归分析显示，年龄（OR=1.03，95%CI 1.01~1.05，P<0.05）、体质指数（OR=1.14，95%CI 1.07~1.23，P<0.05）、左侧海马区N?乙酰天门冬氨酸/肌酸（NAA/Cr）（OR=1.563，95%CI 1.02~2.44，P<0.05）和Cho/Cr（OR=0.506，95%CI 0.26~0.98，P<0.05）是OSAHS的独立危险因素。结论 T2DM患者中OSAHS患病率较高，体质指数、年龄是OSAHS的危险因素。T2DM合并OSAHS患者存在海马区和脑干区的神经介质代谢异常。
목적평고2형당뇨병（T2DM）환자중조새성수면호흡잠정저통기종합정(OSAHS)적환병상황，병분석기영향인소，탐토시부여뇌조직신경개질수평존재관련。방법련속수집2012년9월지2014년9월우상해시동방의원내분비과주원적T2DM환자328례，기중남182례，녀146례，평균년령（63±13）세。사용편휴식수면호흡감측의평고수면호흡잠정저통기지수（AHI），장환자분위단순T2DM조125례，T2DM합병OSAHS조203례。대기중132례환자채용뇌질자자공진파보법검측좌측해마구화좌측뇌간구뇌조직신경개질수평。조간균수비교채용독립양본t검험，솔적비교채용χ2검험。결과 T2DM환자중OSAHS환병솔61.9%（203/328례）。여비OSAHS조비교，OSAHS조환자재년령、체질지수、요위、둔위、좌측해마구적담감/기산（Cho/Cr）화좌측뇌간구적담감/N?을선천문동안산(Cho/NAA)수평화고혈압환병솔등차이균유통계학의의（t=-2.038、-3.391、-2.577、-2.576，Z=-1.923、-2.06，χ2=5.746，균P<0.05）。당뇨병병정、체질지수、고혈압환병솔재경도화중중도OSAHS조지간존재명현차이（t=-2.074、-3.923，χ2=4.524，균P<0.05）。Logistic회귀분석현시，년령（OR=1.03，95%CI 1.01~1.05，P<0.05）、체질지수（OR=1.14，95%CI 1.07~1.23，P<0.05）、좌측해마구N?을선천문동안산/기산（NAA/Cr）（OR=1.563，95%CI 1.02~2.44，P<0.05）화Cho/Cr（OR=0.506，95%CI 0.26~0.98，P<0.05）시OSAHS적독립위험인소。결론 T2DM환자중OSAHS환병솔교고，체질지수、년령시OSAHS적위험인소。T2DM합병OSAHS환자존재해마구화뇌간구적신경개질대사이상。
Objective To evaluate the status of obstructive sleep apnea hypopnea syndrome (OSAHS) in patients with type 2 diabetes, and to investigate the association with neurotransmitter levels in cerebral tissue. Methods The status of OSAHS was evaluated using portable sleep apnea monitor in 328 patients with type 2 diabetes who was hospitalized from September 2012 to September 2014 in Department of Endocrinology, Shanghai East Hospital, of which brain proton magnetic resonance spectroscopy was performed in 132 patients to detect neurotransmitter levels in the left hippocampus and left brainstem area. Patients were divided into T2DM without OSAHS group (125 cases) and T2DM with OSAHS group (203 cases) according hypopnea index (AHI). Measurement data between two groups were compared by using t test, count data rate were compared by usingχ2 test. Results The prevalence of OSAHS was 61.9%(203/328) in patients with type 2 diabetes mellitus. There were significant differences in age, body mass index (BMI), waist circumference, hip circumference, Cho/Cr level in the left hippocampus and Cho/NAA level in the left brainstem area and prevalence rate of hypertension in patients with OSAHS compared that with non?OSAHS (t=-2.038,-3.391,-2.577,-2.576,Z=-1.923、-2.06, χ2=5.746,all P<0.05). There were significant differences in diabetes duration, body mass index, prevalence rate of hypertension in patients with severe OSAHS compared that with mild OSAHS (t=-2.074,-3.923,χ2=4.524, all P<0.05). Logistic regression analysis showed that age(OR1.03,95%CI 1.01-1.05,P<0.05), body mass index(OR=1.14,95%CI 1.07-1.23,P<0.05), NAA/Cr(OR=1.563,95%CI 1.02-2.438,P<0.05) and Cho/Cr level(OR=0.506,95%CI 0.263-0.976,P<0.05)in the left hippocampus were independent risk factors of OSAHS. Conclusions There is higher prevalence of OSAHS in patients with type 2 diabetes. BMI and age are the risk factors of OSAHS. There are abnormal metabolic changes in neurotransmitter levels in the left hippocampus and left brainstem area in diabetic patients with OSAHS.