阻塞性呼吸睡眠暂停低通气综合征患者胰岛抵抗与糖耐量受损分析
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摘要
目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者胰岛素抵抗与糖耐量受损的原因。方法 2008年1月至2013年4月首次在新疆医科大学第一附属医院呼吸睡眠检测室就诊的患者中筛选出符合入选标准的OSAHS患者51例,并根据呼吸暂停低通气指数和最低脉搏氧饱和度将OSAHS患者分为轻度OSAHS组、中度OSAHS组、重度OSAHS组;同时选取经过成组匹配的71例非OSAHS患者作为对照组,对四组分别进行口服葡萄糖耐量试验(OGTT),检测空腹血糖、餐后2 h血糖、空腹胰岛素、餐后2 h胰岛素、糖化血红蛋白、血清总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇以及尿酸等检测,采用稳态模型评估法(HOMA)评价并计算胰岛素抵抗指数(HOMA-IR)。采用Pearson卡方检验、单因素方差分析和多元方差分析进行数据统计。结果对照组与轻度OSAHS组、中度OSAHS组和重度OSAHS组的对照结果显示:四组性别、年龄、民族的差异无统计学意义(P>0.05);四组间体质量指数、空腹血糖、餐后2 h血糖、空腹胰岛素、餐后2 h胰岛素、糖化血红蛋白、胰岛素抵抗指数及尿酸比较,差异有统计学意义(P<0.05),而四组间脂代谢紊乱情况的差异无统计学意义(P>0.05);相关分析显示,中度OSAHS组患者与重度OSAHS组患者存在胰岛素抵抗和胰岛素峰值延长。结论 OSAHS患者出现糖耐量异常可能与胰岛素分泌不足、胰岛素分泌延迟、胰岛素抵抗、胰岛素敏感性下降和胰岛功能减退有关。结果中缺少数据,若要明确哪组的指标比哪组高或低,不能只笼统表述有无意义.
Objective To discuss the reason of insulin resistance and impaired glucose tolerance in patient with obstructive sleep apnea hypopnea syndrome( OSAHS). Methods A total of 51 patients who visited the sleep and breath examination room in the First Affiliated Hospital of Xinjiang Medical University from Jan. 2008 to Apr. 2013 met the inclusion criteria of OSAHS,they were selected and divided into groups of mild,moderate and severe degree of OSAHS according to apnea hypopnea index and minimum pulse rate oxygen saturation,meanwhile a control group of 71 non-OSAHS patient was selected,OGTT,fasting plasma glucose,2 hour post-prandial glucose,fasting serum insulin,2 hour post-prandial insulin,glycosylated hemoglobin,total cholesterol,triglyceride,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol and uric acid of the four groups were tested,and then insulin resistance index were evaluated and calculated using Homeostasis Model Assessment( HOMA). Data statistics were done applying Pearson chi-square test,one-way ANOVA and MANOVA. Results Comparison of the four groups showed that difference of epidemiologic data was not significant( P > 0. 05),body mass index( BMI),fasting plasma glucose,2 hour post-prandial glucose,fasting serum insulin,2 hour post-prandial insulin,glycosylated hemoglobin,homeostasis model assessment insulin resistance index( HOMA-IR) and uric acid were significantly different( P < 0. 05),difference of dyslipidemia status was not significant( P > 0. 05); related analysis showed the existence of insulin resistance and prolonged peak value of insulin secretion in group of moderate and severe degree OSAHS.Conclusion Abnormal glucose tolerance in OSAHS patients may be correlated with insufficient insulin secretion,delayed insulin secretion,insulin resistance,decreased insulin sensitivity and islet dysfunction.
Objective To discuss the reason of insulin resistance and impaired glucose tolerance in patient with obstructive sleep apnea hypopnea syndrome( OSAHS). Methods A total of 51 patients who visited the sleep and breath examination room in the First Affiliated Hospital of Xinjiang Medical University from Jan. 2008 to Apr. 2013 met the inclusion criteria of OSAHS,they were selected and divided into groups of mild,moderate and severe degree of OSAHS according to apnea hypopnea index and minimum pulse rate oxygen saturation,meanwhile a control group of 71 non-OSAHS patient was selected,OGTT,fasting plasma glucose,2 hour post-prandial glucose,fasting serum insulin,2 hour post-prandial insulin,glycosylated hemoglobin,total cholesterol,triglyceride,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol and uric acid of the four groups were tested,and then insulin resistance index were evaluated and calculated using Homeostasis Model Assessment( HOMA). Data statistics were done applying Pearson chi-square test,one-way ANOVA and MANOVA. Results Comparison of the four groups showed that difference of epidemiologic data was not significant( P > 0. 05),body mass index( BMI),fasting plasma glucose,2 hour post-prandial glucose,fasting serum insulin,2 hour post-prandial insulin,glycosylated hemoglobin,homeostasis model assessment insulin resistance index( HOMA-IR) and uric acid were significantly different( P < 0. 05),difference of dyslipidemia status was not significant( P > 0. 05); related analysis showed the existence of insulin resistance and prolonged peak value of insulin secretion in group of moderate and severe degree OSAHS.Conclusion Abnormal glucose tolerance in OSAHS patients may be correlated with insufficient insulin secretion,delayed insulin secretion,insulin resistance,decreased insulin sensitivity and islet dysfunction.
引文
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[8]杨敏,蔺静,郭燕.阻塞性睡眠呼吸暂停对2型糖尿病患者C肽水平的影响[J].国际内分泌代谢杂志,2011,31(4):228-230.
[9]艾比拜·玉素甫,朱筠,怒荣古丽·买买提,等.阻塞性睡眠呼吸暂停综合征对2型糖尿病患者夜间血糖漂移的影响[J].疾病监测,2012,27(7):558-561.
[10]Festa A,Williams K,D'Agostino R Jr,et al.The natural course of beta-cell function in nondiabetic and diabetic individuals:the insulin resistance atherosclerosis study[J].Diabetes,2006,55(4):1114-1120.
[11]何丽霞,李树华.阻塞性睡眠呼吸暂停低通气综合征患者的胰岛素抵抗现象[J].中国组织工程研究与临床康复,2007,11(12):2337-2340,2344.
[12]何丽霞,李树华,石洪金,等.阻塞性睡眠呼吸暂停低通气综合征与胰岛素抵抗的关系的临床研究[J].临床耳鼻咽喉头颈外科杂志,2007,218):353-355.
[13]Mitsui R,Fukushima M,Nishi Y,et al.Factors responsible for deteriorating glucose tolerance in newly diagnosed type 2 diabetes in Japanese men[J].Metabolism,2006,55(1):53-58.
[14]邵琦,任颖,殷善开,等.OSAS代谢紊乱特征及其与胰岛素抵抗的关系[J].上海交通大学学报:医学版,2007,27(10):1254-1257.
[15]张立强,姚婉贞,王玉柱,等.阻塞性睡眠呼吸暂停低通气综合征与胰岛素抵抗的关系[J].中华内科杂志,2006,45(3):184-187.
[16]徐春明,朱晔涵,王姝,等.慢性间歇低氧对阻塞性睡眠呼吸暂停低通气综合征患者胰岛素功能的影响[J].中华结核和呼吸杂志,2010,33(5):344-349.
[2]中华医学会呼吸病学分会睡眠呼吸障碍学组.阻塞性睡眠呼吸暂停低通气综合征诊治指南(2011年修订版)[J].中华结核和呼吸杂志,2012,35(1):9-12.
[3]刘然,陆菊明,刘剑锋,等.2型糖尿病患者阻塞性睡眠呼吸暂停综合征患病状况及相关因素分析[J].中华老年心脑血管病杂志,2013,15(1):29-31.
[4]Ip MS,Lam B,Ng MM,et al.Obstructive sleep apnea is independently associated with insulin resistance[J].Am J Respir Crit Care Med,2002,165(5):670-676.
[5]陆甘,娄青林,张玉林,等.阻塞性睡眠呼吸暂停低通气综合征与胰岛素抵抗的临床研究[J].中华结核和呼吸杂志,2006,29(4):273-274.
[6]Punjabi NM,Shahar E,Redline S,et al.Sleep-disordered breathing,glucose intolerance,and insulin resistance:the Sleep Heart Health Study[J].Am J Epidemiol,2004,160(6):521-530.
[7]Cass AR,Alonso WJ,Islam J,et al.Risk of obstructive sleep apnea in patients with type 2 diabetes mellitus[J].Fam Med,2013,45(7):492-500.
[8]杨敏,蔺静,郭燕.阻塞性睡眠呼吸暂停对2型糖尿病患者C肽水平的影响[J].国际内分泌代谢杂志,2011,31(4):228-230.
[9]艾比拜·玉素甫,朱筠,怒荣古丽·买买提,等.阻塞性睡眠呼吸暂停综合征对2型糖尿病患者夜间血糖漂移的影响[J].疾病监测,2012,27(7):558-561.
[10]Festa A,Williams K,D'Agostino R Jr,et al.The natural course of beta-cell function in nondiabetic and diabetic individuals:the insulin resistance atherosclerosis study[J].Diabetes,2006,55(4):1114-1120.
[11]何丽霞,李树华.阻塞性睡眠呼吸暂停低通气综合征患者的胰岛素抵抗现象[J].中国组织工程研究与临床康复,2007,11(12):2337-2340,2344.
[12]何丽霞,李树华,石洪金,等.阻塞性睡眠呼吸暂停低通气综合征与胰岛素抵抗的关系的临床研究[J].临床耳鼻咽喉头颈外科杂志,2007,218):353-355.
[13]Mitsui R,Fukushima M,Nishi Y,et al.Factors responsible for deteriorating glucose tolerance in newly diagnosed type 2 diabetes in Japanese men[J].Metabolism,2006,55(1):53-58.
[14]邵琦,任颖,殷善开,等.OSAS代谢紊乱特征及其与胰岛素抵抗的关系[J].上海交通大学学报:医学版,2007,27(10):1254-1257.
[15]张立强,姚婉贞,王玉柱,等.阻塞性睡眠呼吸暂停低通气综合征与胰岛素抵抗的关系[J].中华内科杂志,2006,45(3):184-187.
[16]徐春明,朱晔涵,王姝,等.慢性间歇低氧对阻塞性睡眠呼吸暂停低通气综合征患者胰岛素功能的影响[J].中华结核和呼吸杂志,2010,33(5):344-349.