阻塞性睡眠呼吸暂停综合征患者血清中脂蛋白脂肪酶水平与脂代谢紊乱的相关性  

Association between serum lipoprotein lipase level and dyslipidemia in patients with obstructive sleep apnea syndrome

作　　者：李洁[1] 张艳林[2] 王婧[2] 冯萍[3] 陈锐[2] 曹勇军[1] 刘春风[1] 

机构地区：[1]苏州大学附属第二医院神经内科,215004 [2]苏州大学附属第二医院睡眠中心,215004 [3]苏州大学附属第二医院检验科,215004

出　　处：《中华医学杂志》2014年第6期403-407,共5页National Medical Journal of China

基　　金：国家自然科学基金（81200894）;江苏省自然科学基金-青年基金项目（BK2012172）;教育部高等学校博士学科点专项科研基金（20113201120016）

摘　　要：目的 探讨阻塞性睡眠呼吸暂停综合征（OSAS）患者血清中脂蛋白脂肪酶（LPL）水平与脂代谢紊乱的相关性.方法 收集2011年6月至2013年4月因打鼾在苏州大学附属第二医院睡眠中心行多导睡眠图（PSG）监测的患者158例进行前瞻性研究,按睡眠呼吸暂停低通气指数（AHI）将患者分为单纯鼾症组26例,轻度OSAS组23例,中度OSAS组31例,重度OSAS组78例.根据体质指数（BMI）将单纯鼾症患者分为BMI正常组和超重（肥胖）组.通过酶联免疫吸附法测定血清LPL水平,并与OSAS程度及空腹血总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、极低密度脂蛋白（VLDL）水平进行相关分析,分析BMI正常OSAS患者不同病情与上述血脂指标及LPL水平的关系.并对49例行持续正压通气（CPAP）治疗6个月的OSAS患者治疗前后血清LPL水平进行比较.结果 单纯鼾症组和轻、中、重度OSAS组每2组之间AHI、血氧饱和度（SaO2）夜间最低值（L-SaO2）、SaO2＜90%的时间比率（TS90%）差异均有统计学意义（均P〈0.01）.单纯鼾症组和轻、中重度OSAS组血清LPL逐渐降低,重度组显著低于单纯鼾症组[（37±15）比（45±17）μg/L,P=0.022].重度OSAS组血清TC、TG和LDL显著高于单纯鼾症组（P=0.025、0.001、0.049）,轻中重度OSAS组HDL均显著低于单纯鼾症组（均P〈0.05）.校正年龄、BMI之后血清LPL与TC、LDL呈负相关（r=0.221、0.199）,与AHI、TS90%、氧减指数呈负相关（r=0.231、0.228、0.184）.单纯鼾症组中超重（肥胖）者血清VLDL显著高于BMI正常者[（0.77±0.30）比（0.46±0.23）mmol/L,P=0.034],LPL水平显著低于BMI正常者[（37±10）比（523±23）μg/L,P=0.047].BMI正常OSAS患者血清LPL、HDL显著低于BMI正常单纯鼾症者,而TG、VLDL则显著高于BMI正常单纯鼾症者（均P〈0.05）.49例OSAS患者CPAP治疗6个月后血清LPL水平较治疗前显著升高[（60±6）比（38±Objective To explore the association between serum lipoprotein lipase （LPL） level and dyslipidemia in patients with obstructive sleep apnea syndromes （OSAS）. Methods Overnight polysomnography （PSG） was performed for 158 patients with snoring at our Sleep Center from June 2011 to April 2013. Based on the results of apnea-hypopnea index （ AHI ） assessment, they were divided into 4 groups ： primary snoring （ AHI 〈 5/h, n = 26 ）, mild （ 5/h ≤ AHI ≤ 15/h, n = 23 ） , moderate （ 15/h 〈 AHI≤30/h,n = 31 ） and severe （ AHI 〉 30/h, n = 78 ） OSAS. According to body mass index （ BMI）, primary snoring group was further divided into normal BMI and overweight （obese） groups. The level of LPL was determined by enzyme-linked immunosorbent assay （ELISA） and the correlations were observed with OSAS,blood total cholesterol （TC）, triglyceride （TG）, high density lipoprotein （HDL）, low density lipoprotein （LDL） and very low density lipoprotein （VLDL）. In normal weight OSAS patients, the relationship was analyzed between different conditions, plasma lipid and serum LPL. In 49 OSAS groups, the level of LPL was observed after 6-month continuous positive airflow pressure （CPAP）. Results From a comparison of four groups,it was found that AHI, night blood lowest oxygen saturation （ L-SaO2 ） and time ratio of lowest SaO2 〈 90% （ TS90% ） had statistical significance （ all P 〈 0. 01 ）. The serum LPL gradually decreased in four groups. Compared with primary snoring group, there was a significant increase of serum LPL level in severe OSAS group （ （37 ± 15） vs （45 ± 17） ug/L,P = 0. 022）. And severe OSAS group had significantly higher serum levels of TC ,TG and LDL （P = 0. 025,0. 001,0. 049 ）. HDL of OSAS group was significantly lower than that of primary snoring group （ all P 〈 0.05 ）. Additionally, after adjustment for BMI and age,serum LPL levels showed significant negative correlations with TC and LDL（ r = 0. 221,0. 199 ）

关 键 词：睡眠呼吸暂停 阻塞性 脂肪酶 脂蛋白类 脂代谢障碍 

分 类 号：R766[医药卫生—耳鼻咽喉科]