2型糖尿病合并阻塞性睡眠呼吸暂停综合征病情严重程度与糖脂代谢、炎症因子及肾功能的相关性研究*

Study on relationship between severity of obstructive sleep apnea syndrome and glycolipid metabolism, inflammatory factors and renal function in patients with type 2 diabetes mellitus combined with obstructive sleep apnea syndrome*

摘要:

目的 探讨2型糖尿病合并阻塞性睡眠呼吸暂停综合征（OSAS）病情严重程度与糖脂代谢、炎症因子及肾功能的相关性。方法 按照每小时睡眠呼吸暂停次数（AHI）将2016年3月—2018年6月右江民族医学院附属医院收治的123例2型糖尿病患者分为单纯糖尿病组（39例，AHI<5次/h）、OSAS轻度组（32例，AHI 5～15次/h）、OSAS中度组（28例，AHI 16～30次/h）和OSAS重度组（24例，AHI>30次/h），同期随机选取40例健康体检者为对照组。比较各组睡眠呼吸指标：AHI、最低动脉血氧饱和度（LSaO2）、夜间动脉平均血氧饱和度（MSaO2），血糖指标：空腹血糖（FBG）、餐后2?h血糖（2?h PBG）、糖化血红蛋白（HbA1c），血脂指标：总胆固醇（TC）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、甘油三酯（TG），炎症因子指标：白细胞介素-6（IL-6）、白细胞介素-8（IL-8）、肿瘤坏死因子-α（TNF-α）、高敏C反应蛋白（hs-CRP）、胞间黏附分子-1（ICAM-1），以及肾功能：血清肌酐（Scr）、肾小球滤过率（eGFR），并分析睡眠呼吸指标与糖脂代谢指标、炎症因子指标及肾功能指标的相关性。结果 2型糖尿病患者体重指数（BMI）、FBG、HbA1c、TC、LDL、TG高于对照组，HDL低于对照组（P?<0.05），OSAS轻、中、重度组患者FBG、HbA1c、TC、LDL、TG高于单纯糖尿病组，HDL低于单纯糖尿病组（P?<0.05）。2型糖尿病患者血清IL-6、IL-8、TNF-α、hs-CRP、ICAM-1水平均高于对照组（P?<0.05），OSAS轻、中、重度组患者上述指标高于单纯糖尿病组（P?<0.05）。2型糖尿病患者eGFR水平低于对照组（P?<0.05），OSAS轻、中、重度患者eGFR水平低于单纯糖尿病组（P?<0.05）。糖尿病肾脏疾病（DKD）组患者AHI高于非DKD组，LSaO2、MSaO2低于非DKD组（P?<0.05）。经Pearson相关分析，AHI与BMI、FBG、HbA1c、TC、LDL、TG、IL-6、IL-8、TNF-α、hs-CRP、ICAM-1呈正相关（P?<0.05），LSaO2、MSaO2与上述指标呈负相关（P?<0.05）；AHI与HDL、eGFR呈负相关（P?<0.05），LSaO2、MSaO2与HDL、eGFR呈正相关（P?<0.05）。结论 OSAS可致2型糖尿病患者糖脂代谢异常、炎症反应加剧及肾功能损伤，并且OSAS病情越严重，患者糖脂代谢异常越明显，炎症反应越重，肾功能损伤越严重。

Abstract:

Objective To explore the relationship between severity of obstructive sleep apnea syndrome (OSAS) and glycolipid metabolism, inflammatory factors and renal function in patients with type 2 diabetes mellitus combined with obstructive sleep apnea syndrome. Methods From March 2016 to June 2018, 123 patients with type 2 diabetes mellitus who were admitted to our hospital according to the hourly apnea-hypopnea index (AHI) were divided into simple diabetes mellitus group (n?=?39, AHI < 5?times/h), OSAS mild group (n?=?32, AHI 5 to 15 times/h), OSAS moderate group (n?=?28, AHI 16 to 30 times/h) and OSAS severe group (n?= 24, AHI > 30 times/h). At the same time, 40 healthy volunteers were randomly selected as control group. The apnea-hypopnea index (AHI), low arterial oxygen saturation (LSaO2), mean arterial oxygen saturation (MSaO2), blood glucose indexes such as fasting blood glucose (FBG), 2 hour postprandial blood glucose (2?h PBG), glycosylated hemoglobin (HbA1c), and blood lipid indexes such as total gholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), triglyceride (TG), and inflammatory factors indexes such as interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α), high sensitivity C-reactive protein (hs-CRP), intercellular adhesion molecular 1 (ICAM-1), and renal function indexes such as serum blood creatinine (Scr) and eGFR were compared among groups. And the relationships between sleep respiration indexes and glucose and lipid metabolism indexes, and inflammatory factors indexes and renal function indexes were analyzed. Results The BMI, FBG, HbA1c, TC, LDL, TG in patients with type 2 diabetes mellitus were higher than those in control group, and HDL was lower than that in control group (P?< 0.05). The FBG, HbA1c, TC, LDL, TG in OSAS mild, moderate and severe group were higher than those in simple diabetes mellitus group, and HDL was lower than that in simple diabetes mellitus group (P?