男性代谢综合征伴睡眠呼吸暂停患者血清代谢指标及脂肪因子变化  

Changes of serum metabolic markers and adipokines in male patients with metabolic syndrome and sleep apnea

作　　者：周斌[1] 蒋晓真[1] 陈蕊华[1] 奚峰[2] 秦玉兰[1] ZHOU Bin;JIANG Xiaozhen;CHEN Ruihua;XI Feng;QIN Yulan(Department of Endocrinology,Pudong New Area People′s Hospital,Shanghai 201299,China;不详)

机构地区：[1]上海市浦东新区人民医院内分泌科,上海201299 [2]上海市浦东新区人民医院呼吸内科,上海201299

出　　处：《实用医学杂志》2020年第1期79-83,共5页The Journal of Practical Medicine

基　　金：上海市卫生和计划生育委员会科研基金项目（编号：201640207）;浦东新区卫生和计划生育委员会科研基金项目（编号：PW2015B-12,PW2016A-22)

摘　　要：目的探讨睡眠呼吸暂停-低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)合并代谢综合征(metabolic syndrome,MetS)男性患者外周血代谢指标及脂肪因子的变化。方法入组男性健康志愿者(NC组)39例,MetS患者(Met组)31例,OSAHS合并MetS患者(OM组)68例。进行多导联睡眠监测(polylead sleep monitoring,PSG)检查,比较3组对象的临床和生化参数、血浆C反应蛋白(C-reactive protein,C-CRP)、瘦素(leptin,LEP)、脂联素(adiponectin,ADP)、内脏脂肪素(visfatin,VF)、人摄食抑制因子-1(nesfatin-1,NES-1)水平。结果3组资料比较:OM组的颈围、腰围、腰臀比、FPG、FINS、HOMA-IR、HbA1c、LDL-C、CRP、LEP、AHI、ODI显著高于NC组和Met组(P<0.05),最低SaO2、NES-1和ADP低于另两组(P<0.05)。多因素分析结果显示,MetS男性中发生OSAHS的独立影响因素为腰围(95%CI:1.016~1.410)、FINS(95%CI:1.341~3.336)、HbA1c(95%CI:1.334~7.374)、LDL-C(95%CI:1.476~9.701)和NES-1(95%CI:0.414~0.918)(R2=0.744)。结论MetS合并OSAHS的男性患者存在更严重的向心性肥胖、胰岛素抵抗和糖代谢异常。NES-1的降低可能对MetS患者发生OSAHS具有重要的提示意义。Objective To investigate the changes of peripheral blood metabolic markers and adipokines in male patients with obstructive sleep apnea-hypopnea syndrome(OSAHS)and metabolic syndrome(MetS).Methods This study involved 39 male healthy volunteers(N C group),31 MetS patients(Met group),and 68 patients with OSAHS and MetS(OM group)by using polysomnography(PSG).Clinical and biochemical parameters,plasma CRP,LEP,APN,visfatin,and nesfatin-1 levels were compared and analyzed among the three groups.Results Neck circumference,waist circumference,waist-to-hip ratio,FPG,FINS,HOMA-IR,HbA1c,LDL-C,CRP,LEP,AH1,and ODI levels were significantly larger and higher in OM group than those in NC group and Met group(P<0.05),while lowest SaO2,NES-1 and ADP were lower than those in the other two groups(P<0.05).Multivariate analysis showed that independent influencing factors of OSAHS in men with metabolic syndrome were waist circumference(95%CI:1.016~1.410),FINS(95%GI:1.341~3.336),HbA1c(95%CI:1.334~7.374),LDL-C(95%CI:1.476~9.701)and NES-1(95%CI:0.414~0.918)(R2=0.744).Conclusions Male patients with OSAHS and MetS present more severe central obesity,insulin resistance,and abnormal glucose metabolism.The reduction of NES-1 may independently predict the development of OSAHS in patients with MetS.

关 键 词：代谢综合征 阻塞性睡眠呼吸暂停低通气综合征 炎症因子 脂肪因子 瘦素 脂联素 

分 类 号：R825.8[医药卫生—临床医学]