阻塞性呼吸暂停综合征对冠心病患者糖代谢及氧化低密度脂蛋白胆固醇水平的影响  

The Influence of Obstructive Sleep Apnea Syndrome on ox-LDL-C Levels and Glucose Metabolism of Patients with Coronary Heart Disease

作　　者：高兴[1] 李文章[2] 

机构地区：[1]成都市第六人民医院呼吸内科,成都610041 [2]成都医学院第一附属医院心内科,成都610401

出　　处：《医学综述》2016年第8期1579-1582,共4页Medical Recapitulate

摘　　要：目的探讨阻塞性睡眠呼吸暂停综合征(OSAS)对冠心病患者糖代谢及氧化低密度脂蛋白胆固醇(ox-LDL)的影响。方法选择2009年9月至2013年9月在成都市第六人民医院呼吸科和心内科住院、冠状动脉造影确诊冠心病的患者410例,根据呼吸暂停低通气指数(AHI)分为冠心病组(90例)和冠心病合并OSAS组(320例)。根据AHI严重程度将冠心病合并OSAS患者分为3个亚组:轻度86例、中度108例和重度126例。对两组患者进行口服糖耐量胰岛素释放试验、糖化血红蛋白(HbA_(1c))及ox-LDL-C水平检测。结果冠心病合并OSAS中、重度组空腹血糖、胰岛素抵抗指数(HOMA-IR)、糖化血红蛋白(HbA_(1c))、ox-LDL-C分别为(6.7±1.2)mmol/L、3.3±0.4、(5.8±0.6)%、(102±23)mmol/L和(7.9±2.1)mmol/L、3.9±0.5、(6.6±0.7)%、(137±25)mmol/L,均高于冠心病组[(5.5±0.6)mmol/L、2.6±0.3、(4.6±0.6)%、(85±21)mmol/L]和轻度组[(5.6±0.6)mmol/L、2.7±0.3、(4.7±0.6)%、(85±22)mmol/L],重度组高于中度组,差异均有统计学意义(P<0.01)。AHI与FPG、HOMA-IR、HbA_(1c)、ox-LDL-C呈正相关(r=0.76,P=0.00;r=0.79,P=0.00;r=0.78,P=0.00;r=0.79,P=0.00)。结论 OSAS增加了冠心病患者糖代谢异常的风险,其机制与低氧血症引起的胰岛素抵抗及血浆ox-LDL升高相关。Objective To investigate the influence of obstructive sleep apnea syndrome（ OSAS） on the glucose metabolism and oxidized low density lipoprotein cholesterol（ ox-LDL） of coronary heart disease（ CHD） patients. Methods Total of 410 CHD patients admitted to Pneumology Department and Cardiology Department of Chengdu Sixth People＇s Hospital from Sep. 2009 to Sep. 2013 were divided into CHD group（ 90 cases） and CHD combined with OSAS group（ 320 cases） according to the apnea hypopnea index（ AHI）. And the CHD combined with OSAS group was further divided into mild,moderate,and severe subgroup according to AHI severity. Then oral glucose tolerance insulin releasing test,glycosylated hemoglobin（ HbA_（1c）） and ox-LDL-C examination were conducted. Results The fasting glucose,insulin resistance index（ HOMA-IR）,Hb A1 c,ox-LDL-C,AHI in CHD patients combined with moderate[（ 6. 7 ± 1. 2） mmol/L,3. 3 ± 0. 4,（ 5. 8 ± 0. 6） %,（ 102 ± 23） mmol / L] to severe OSAS [（ 7. 9 ± 2. 1） mmol / L,3. 9 ± 0. 5,（ 6. 6 ± 0. 7） %,（ 137 ± 25） mmol/L] were higher than CHD group[（ 5. 5 ± 0. 6） mmol/L,2. 6 ± 0. 3,（ 4. 6 ± 0. 6） %,（ 85 ± 21） mmol/L]and CHD with mild OSAS group[（ 5. 6 ± 0. 6） mmol/L,2. 7 ± 0. 3,（ 4. 7 ± 0. 6） %,（ 85 ± 22） mmol/L]. Those parameters were also higher in CHD patients combined with severe OSAS when comparing those with moderate OSAS（ P〈 0. 01）. AHI was positively correlated with FPG,HOMA-IR,Hb A1 c,ox-LDL-C（ r = 0. 76,P = 0. 00; r = 0. 79,P = 0. 00; r = 0. 78,P = 0. 00; r = 0. 79,P =0. 00）. Conclusion OSAS increases the risk of glucose metabolic disorder in CHD patients,which may be related to the insulin resistance and elevated plasma ox-LDL level caused by hypoxemia.

关 键 词：冠心病 阻塞性睡眠呼吸暂停综合征 低通气指数 胰岛素抵抗 

分 类 号：R563[医药卫生—呼吸系统]