摘要
目的探讨青年肥胖阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者糖代谢异常的影响因素。方法纳入2012年1月至2014年12月行多导睡眠监测（PSG）的青年肥胖者106例，其中男74例，女32例，年龄18—44岁，体质指数（BMI）≥30kg／m^2106例患者中OSAHS组59例，非OSAHS组47例。所有患者于PSG监测次日清晨行口服葡萄糖耐量-胰岛素释放试验（OGTT—IRT），检测血清糖化血红蛋白（HbA1c）。计算稳态模型胰岛素抵抗指数（HOMA—IR）、Matsuda胰岛素敏感性指数（MI）、稳态模型胰岛β细胞功能指数（HOMA—β）、早时相胰岛素分泌指数（△I30／△G30）、180min胰岛素曲线下面积（AUC-I180）及口服处理指数（DIo），比较组间差异，并采用多元逐步回归法分析相关影响因素。结果OSAHS组合并糖尿病比例显著高于非OSAHS组（22．0％比4．3％，P=0．009）。OSAHS组OGTT0、30和60min血糖和HbA，C值均显著高于非OSAHS组（均P〈0．05）。OSAHS组DIo显著低于非OSAHS组（P=0．024），HOMA—IR、MI、HOMA—β、△I30／△G30、AUC—Im两组间差异均无统计学意义（均P〉0．05）。多元逐步回归分析显示OGTT0、30和60min血糖与氧减指数（ODI）呈独立正相关（β=0．243，0．273和0．371，均P〈0．05）。HOMA—β与呼吸暂停低通气指数（AHI）呈独立负相关（β=-0．243，P=0．011），DIo与ODI呈独立负相关（β=-0．234，P=0．031）。结论青年肥胖OSAHS患者较单纯肥胖者有更显著的糖代谢异常和胰岛B细胞代偿功能减退，与夜间呼吸暂停相关的低氧事件独立相关。
Objective To explore the factors influencing glucose metabolism in young obese subjects with obstructive sleep apnea hypopnea syndrome （OSAHS）. Methods A total of 106 young obese subjects[ 18 -44 years old, body mass index （BMI）≥30 kg/m^2] were enrolled and divided into two groups based on full-night polysomnography （PSG）, OSAHS group [ apnea hypopnea index （AHI） ≥ 5 events/hi and non-OSAHS group （AHI 〈 5 events/h）. Oral glucose tolerance-insulin releasing test （OGTT-IRT） was performed and serum glycosylated hemoglobin A1 （HbA1 c） levels were measured after an overnight fast. Homeostasis model assessment-IR （HOMA-IR）, Matsuda insulin sensitivity index （MI）, homeostasis model assessment-β （HOMA-β）, the early phase insulinogenic index （△I30/△G30）, total area under the curve of insulin in 180 minutes （AUC-IIso ） and oral disposition index （DIo） were calculated to evaluate insulin resistance and pancreatic β cell function. Stepwise multiple linear regressions were conducted to determine the independent linear correlation of glucose measurements with PSG parameters. Results Prevalence of diabetes was higher in OSAHS than in non-OSAHS group （22. 0% vs 4. 3 %, P = 0. 009）. OGTT 0, 30, 60 min glucose and HbAj c levels were higher in OSAHS group than those in non-OASHS group （ all P 〈 0. 05 ）. DIo were lower in OSAHS group than those in non-OASHS group （P =0. 024） , HOMA-IR, MI, HOMA-β, △I30/△G30, and AUC-I180 were similar between two groups （ all P 〉 0. 05 ）. In stepwise multiple linearregressions, OGTT 0, 30 and 60 rain glucose were positively correlated with oxygen desaturation index （ODI） （ β =0. 243, 0. 273 and 0. 371 respectively, all P 〈0. 05）. HOMA-β was negatively correlated with AHI （ β = - 0. 243, P = 0. 011 ）. DIo was negatively correlated with ODI （β= - 0. 234, P = 0. 031 ）. Conclusion OSAHS worsens glucose metabolism and compensatory pancreatic β-cell function in young obese subiects, which could
出处
《中华医学杂志》
CAS
CSCD
北大核心
2016年第18期1405-1409,共5页
National Medical Journal of China
基金
基金项目：国家自然科学基金（81400065,81070068,81270148）
上海市科委基础研究重点项目（11JC1411302）
中国睡眠研究会青年科研基金（2014-05）
