持续正压通气可改善2型糖尿病伴阻塞性睡眠呼吸暂停低通气综合征患者炎症及胰岛素抵抗  

Improvement on inflammation and insulin resistance after continuous positive airway pressure in patients with type 2 diabetes mellitus and obstructive sleep apnea hypopnea syndrome

作　　者：李晨光[1] 陈莉明[1] 倪长霖[1] 常宝成[1] 李竹[1] 杨敏[1] 汤云昭[1] 姜振环[1] 朱艳娟[1] 

机构地区：[1]天津医科大学代谢病医院内分泌研究所、卫生部激素与发育重点实验室,300070

出　　处：《中华糖尿病杂志》2014年第10期737-741,共5页CHINESE JOURNAL OF DIABETES MELLITUS

摘　　要：目的 观察持续正压通气（CPAP）对2型糖尿病（T2DM）伴阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者炎症和胰岛素抵抗的影响.方法 选择2012年1月至2014年1月诊断为T2DM伴OSAHS的患者74例,按随机数字表法分为干预组和对照组各37例.其中男51例,女23例,年龄45～ 66岁.干预组接受14d的CPAP治疗.检测治疗前后空腹血糖（FBG）、果糖胺（FMN）、空腹胰岛素（FINS）、白细胞（WBC）计数、超敏C反应蛋白（hs-CRP）、缺氧诱导因子1α（HIF-1α）和可溶性血管内皮细胞黏附因子-1 （sVCAM-1）.以稳态模型分析法（HOMA）评估稳态模型的胰岛素抵抗指数（HOMA-IR）,多导睡眠图（PSG）监测治疗前后平均血氧饱和度（MSpO2）、最低血氧饱和度（LSpO2）、睡眠呼吸暂停指数（AHI）.采用t检验、卡方检验、Spearman相关分析进行数据统计.结果 干预组FBG、FMN、FINS、MSpO2、LSpO2、AHI均有不同程度的改善（￡=-123.761～120.676,均P＜0.05）,hs-CRP、HIF-1α、sVCAM-1、HOMA-IR治疗后较治疗前均显著下降[（2.4±0.4）比（7.3±0.3）mg/L、（211±6）比（275±53）ng/L、（589±57）比（717±73） ng/L,2.1±0.7比3.7-±0.2,t=-53.046、-19.827、-12.827、-28.342,均P＜0.05].Pearson相关分析示干预组治疗后HOMA-IR改善程度与HIF-1α、sVCAM-1改善程度呈正相关（r=0.87、0.86,均P＜0.05）.结论 CPAP可改善T2DM伴OSAHS患者炎症状态,提高睡眠质量,改善胰岛素抵抗.Objective To observe the effects of continuous positive airway pressure（CPAP） treatment on inflammation and insulin resistance in patients with type 2 diabetes mellitus（T2DM） and obstructive sleep apnea-hypopnea syndrome （OSAHS）.Methods Seventy-four patients （51 males and 23 females,with an age range of 45-66 years old） diagnosed as T2DM and OSAHS syndrome from January 2012 to January 2014 were randomly and equally divided into the treatment group（n=37） and the control group（n=37）.Patients in the treatment group were treated with CPAP for 14 days.The fasting blood glucose （FBG）,fructosamine （FMN）,fasting insulin （FINS）,white blood cell （WBC）count,high sensitive C reactive protein （hs-CRP）,hypoxia inducible factor-1α （HIF-1α） and soluble vascular cell adhesion molecule-1（sVCAM-1） was detected before and after treatment.The homeostasis model assessment （HOMA） insulin resistance （HOMA-IR） index,the mean pulse oxygen saturation （MSpO2）,the lowest pulse oxygen saturation （LSpO2） and apnea hypopnea index （AHI） were monitored by polysomnography （PSG） before and after treatment.T test,χ^2 test and Spearman correlation analysis were used to evaluate the data.Results Compared to the control group,the level of FBG,FMN,FINS,MSpO2,LSpO2,AHI was improved in the treatment group by a certain degree after treatment （t =-123.761-120.676,all P〈0.05）.The level of hs-CRP,HIF-1α,sVCAM-1 and HOMA-IR was significantly reduced from （7.3±0.3）mg/L,（275±53） ng/L,（717±73） ng/L and 3.7±0.2 before treatment to （2.4±0.4） mg/L,（21 1±6） ng/L,（589±57） ng/L and 2.1±0.7 after treatment,respectively （t=-53.046,-19.827,-12.827,-28.342,respectively,all P〈0.05）.The improvements showed by Pearson analysis in HOMA-IR after treatment were positively correlated with HIF-1α and sVCAM-1 improvements r=0.87,0.86,both P〈0.05）.Conclusion CPAP may improves the inflammation status,sleep quality,insulin resistance in patients with T2DM an

关 键 词：睡眠呼吸暂停 阻塞性 糖尿病 2型 炎症因子 

分 类 号：R766[医药卫生—耳鼻咽喉科]