胰岛素抵抗和β细胞功能缺陷与睡眠呼吸暂停综合征的关系  

Relationship of insulin resistance and beta cell dysfunction with obstructive sleep apnea syndrome

作　　者：贾恩志[1] 李爱香[2] 徐振霞[2] 张希龙[3] 胡玲[3] 

机构地区：[1]南京医科大学第一附属医院心内科,江苏省南京市210029 [2]济宁市第二人民医院急诊科,山东省济宁市272049 [3]南京医科大学第一附属医院呼吸科,江苏省南京市210029

出　　处：《中国临床康复》2004年第30期6649-6651,共3页Chinese Journal of Clinical Rehabilitation

摘　　要：目的:研究胰岛素抵抗、β细胞功能缺陷与睡眠呼吸暂停综合征的关系。方法:选择行多导睡眠图检查并证实为睡眠呼吸暂停综合征的患者102例,其中男性84例,女性18例。所有患者均测量体质量指数、腰围、颈围及血压,检测空腹真胰岛素、胰岛素原、血糖、血脂及尿酸,分别采用HOMA指数及胰岛素原的水平作为衡量胰岛素抵抗及β细胞功能缺陷的指标;采用最低血氧饱和度<80%作为重度睡眠呼吸暂停综合征的判断标准。应用Spearman相关分析、单因素及多因素Logistic分析等方法进行统计分析。结果:Spearman相关分析示最低血氧饱和度与HOMA指数及胰岛素原显著负相关(r=-0.294,-0.339;P<0.01);单因素Logistic分析结果示及胰岛素原均为重度睡眠呼吸暂停综合征的危险因素,其OR(95%CI)分别为1.926(1.303～2.846)及1.716(1.176～2.505),多因素逐步Logistic回归分析显示,HOMA指数为重度睡眠呼吸暂停综合征的独立的危险因素,其OR值及其95%可信区间为1.991(1.308～3.030),P=0.001。结论:睡眠呼吸暂停综合征与胰岛素抵抗交互作用,初步证实了Z综合征的存在。AIM:To explore the relation of insulin resistance and beta(β) cell dysfunction with obstructive sleep apnea syndrome(OSAS).METHODS:Totally 102 patients(84 males and 18 females),who underwent polysomnography in the Sleep Center of Nanjing Medical University and were diagnosed to have OSAS.Body mass index(BMI),waist circumference,neck circumference and blood pressure were measured,fasting plasma specific insulin,proinsulin,blood glucose,blood lipid and blood uric acid were determined in all the patients.The insulin resistance and βcell dysfunction were assessed by homeostasis model assessment(HOMA) index and proinsulin level respectively,and the severe OSAS was defined as the lowest oxyhemoglobin saturation less than 80%.The Spearman correlation analysis,univariate Logistic regression and multivariate stepwise Logistic regression analysis were used for statistical analysis.RESULTS:The Spearman correlation analysis showed that there was significantly negative correlation between the lowest oxyhemoglobin saturation and Homa index(r=-0.294,-0.339;P< 0.01).The results of univariate Logistic regression analysis suggested that the level of HOMA(quartile) and proinsulin(quartile)were btoh the risk factors for severe OSAS and the odds ratio(OR)(95%confident interval,CI) was 1.926(1.303 to 2.846) and 1.716(1.176 to 2.505) respectively.The results of multivariate stepwise Logistic regression analysis indicated that the HOMA index(quartile) was the independent risk factor for the severe OSAS,and the OR(95%CI) was 1.991(1.308 to 3.030)(P=0.001).CONCLUSION:The OSAS interacts with insulin resistance and may be the feature of syndrome Z.

关 键 词：睡眠呼吸暂停综合征 胰岛素抵抗 Β细胞功能 胰岛素原 重度 LOGISTIC分析 患者 结论 指数 水平 

分 类 号：R587.1[医药卫生—内分泌] R766.43[医药卫生—内科学]