男性肥胖型与非肥胖型OSAHS和胰岛素抵抗的相关分析

男性肥胖型与非肥胖型OSAHS和胰岛素抵抗的相关分析

冯文雯潘幸周昭远

【摘要】目的探讨男性肥胖型与非肥胖型阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与胰岛素抵抗(IR)之间的关系。方法将因睡眠呼吸问题而就诊的88例男性患者纳入研究，根据多导睡眠图(PSG)、BMI及睡眠呼吸暂停低通气指数(AHI)将88例分为非肥胖型OSAHS组28例(OSAHS轻度组10例，中重度组18例)、肥胖型OSAHS 组26例(轻度组10例，中重度组16例)、单纯肥胖组18例和对照组16例。测定各组空腹血糖、空腹胰岛素(FINS)、总胆固醇、甘油三酯、LDL-C、 HDL-C,并计算胰岛素抵抗指数(HOMA-IR)，比较各组的上述指标，并采用Pearson相关与多重线性逐步回归分析AHI与各指标间、HOMA-IR与各指标间的相关性。结果肥胖型OSAHS组的空腹血糖、FINS、HOMA-IR、总胆固醇、甘油三酯、LDL-C水平均高于单纯肥胖组(P均<0.05)，非肥胖型OSAHS 组上述指标的水平也均高于对照组(P均<0.05)。中重度OSAHS组的糖脂异常、IR程度均较相应的轻度组严重(P均<0.05)。OSAHS患者的AHI与HOMA-IR、总胆固醇、甘油三酯、LDL-C均呈正相关(P均<0.05)；非肥胖型OSAHS组中影响AHI的因素是HOMA-IR，影响HOMA-IR的因素是AHI。结论在男性患者中，OSAHS与IR相关且独立于肥胖因素，IR程度随着OSAHS病情的加重而增加。

【关键词】肥胖型；非肥胖型；阻塞性睡眠呼吸暂停低通气综合征；胰岛素抵抗

收稿日期：(2015-05-08)

DOI:10.3969/g.issn.0253-9802.2015.10.009

通讯作者，玛依努尔·艾力，E-mail:mayinur224@126.com

Correlation of obstructive sleep apnea-hypopnea syndrome and insulin resistance in obese or non-obese male patientsFengWenwen,PanXing,ZhouZhaoyuan.DepartmentofEndocrinology,theFirstAffiliatedHospitalofGuangdongPharmaceuticalUniversity,Guangzhou510080,China

Correspondingauthor,ZhouZhaoyuan

Abstract【】ObjectiveTo investigate the relationship between obstructive sleep apnea-hypopnea syndrome (OSAHS) and insulin resistance (IR) in obese or non-obese male patients. MethodsAccording to polysomnography (PSG), body mass index (BMI) and apnea hypopnea index (AHI), 88 patients with sleep-related breathing disorders were divided into four groups: non-obese OSAHS group (n=28; 10 with mild and 18 with moderate and severe OSAHS), obese OSAHS group (n=26; 10 with mild and 16 with moderate and severe OSAHS), obese group (n=18) and control group (n=16). Fasting glucose, fasting insulin (FINS), serum total cholesterol, triglyceride, low density lipoprotein (LDL-C), high density lipoprotein (HDL-C) were measured and insulin resistance index (HOMA-IR) was calculated and statistically compared among all groups. The correlation between AHI and each index, and between HOMA-IR and each index was analyzed by Pearson correlation and multiple linear regression analyses. ResultsThe levels of fasting glucose, FINS, HOMA-IR, serum total cholesterol, triglyceride and LDL-C in the obese OSAHS group were significantly higher than those in the obese group (all P<0.05). The same difference was observed between the non-obese OSAHS and control groups (all P<0.05). Patients with moderate and severe OSAHS had more severe glucose and lipid metabolism abnormality and IR compared with their counterparts with mild OSAHS (both P<0.05). In the OSAHS patients, AHI was positively correlated with HOMA-IR, serum total cholesterol, triglyceride and LDL-C (all P<0.05). In the non-obese OSAHS group, HOMA-IR was the major factor influencing AHI and AHI was also the major influencing factor of HOMA-IR. ConclusionsIn male OSAHS patients, OSAHS was closely correlated with IR independent of obesity. The severity of IR was deteriorated over the aggravation of OSAHS.

【Key words】Obesity; Non-obesity; Obstructive sleep apnea-hypopnea syndrome;

Insulin resistance

阻塞性睡眠呼吸暂停低通气综合征(OSAHS)以夜间反复上气道塌陷为特征，引起间歇性低氧、高碳酸血症、睡眠片段化以及交感神经兴奋等病理生理变化，导致睡眠状态下反复出现呼吸暂停和(或)低通气[1]。OSAHS与心脑血管疾病、糖尿病、代谢紊乱等密切相关，这些疾病存在一个共同的病理生理状态，即胰岛素抵抗，胰岛素抵抗被认为是代谢紊乱综合征的发病基础，临床上表现为高胰岛素血症、糖耐量异常、高血压病、高脂血症、肥胖等[2]。近年来，许多研究表明随着OSAHS病情的加重，其胰岛素抵抗也呈加重趋势[3-5]。……