利拉鲁肽对2型糖尿病合并阻塞性睡眠呼吸暂停低通气综合征患者睡眠呼吸紊乱及微血管病变的影响  

Effects of liraglutide on sleep-disordered breathing and diabetic microangiopathy in patients with type 2 diabetes mellitus and obstructive sleep apnea-hypopnea syndrome

作　　者：刘凯坤 袁慧娟 王丹钰 袁倩 史晓阳 Liu Kaikun;Yuan Huijuan;Wang Danyu;Yuan Qian;Shi Xiaoyang(Department of Geriatrics,Henan Provincial People′s Hospital,People′s Hospital of Zhengzhou University,Zhengzhou 450003,China;Department of Endocrinology,Henan Provincial People′s Hospital,People′s Hospital of Zhengzhou University,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院,郑州大学人民医院老年医学科,450003 [2]河南省人民医院,郑州大学人民医院内分泌与代谢病科,450003

出　　处：《中华糖尿病杂志》2020年第2期86-91,共6页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：河南省自然科学基金(182300410338);河南省医学科技攻关计划省部共建项目(SBGJ2018078)。

摘　　要：目的探讨胰高糖素样肽-1(GLP-1)类似物对2型糖尿病(T2DM)合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者睡眠呼吸紊乱及微血管病变的影响。方法选取2017年1月至2018年12月河南省人民医院内分泌科及睡眠中心239例T2DM住院患者为研究对象,进行多导睡眠图(PSG)监测及糖尿病微血管病变筛查,纳入患糖尿病微血管病变的T2DM合并OSAHS患者93例,其中利拉鲁肽治疗患者50例作为治疗组,常规降糖治疗患者43例作为对照组,比较两组治疗6个月前后体质指数(BMI)、腰围、糖化血红蛋白(HbA1c)、血压、血脂、尿酸、呼吸暂停低通气指数(AHI)等指标的变化及糖尿病微血管病变改善情况。两组间比较采用t检验、非参数秩和检验或χ2检验,评价各指标与AHI变化值的相关性采用偏相关分析、协方差分析,利拉鲁肽与糖尿病微血管病变改善的相关性采用Logistic回归分析。结果治疗后利拉鲁肽治疗组较对照组BMI、腰围、HbA1c、收缩压、AHI下降更显著[分别为(-1.85±2.46)比(0.02±0.46)kg/m2、(-3.24±10.34)比(-0.07±0.88)cm、(-0.83±0.55)%比(-0.06±0.40)%、(-7.92±14.16)比(-0.56±16.16)mmHg(1 mmHg=0.133 kPa)、(-3.16±3.52)比(0.5±1.54)次/h,t=2.159~7.703,均P<0.05],糖尿病周围神经病变改善比例更高[26.0%(13/50)比9.3%(4/43),χ2=4.315,P<0.05]。治疗后AHI变化值与BMI变化值、腰围变化值、HbA1c变化值呈正相关(r=0.238、0.232、0.317,均P<0.05),与年龄呈负相关(r=-0.21,P<0.05)。调整年龄、糖尿病病程、BMI、腰围、收缩压、HbA1c等因素后,利拉鲁肽与AHI变化值水平有关(F=8.155,P=0.005)。调整年龄、糖尿病病程、BMI、腰围、HbA1c、收缩压、AHI等因素后,多因素Logistic回归分析显示利拉鲁肽对糖尿病周围神经病变有改善作用(OR=3.426,95%CI:1.024~11.46,P=0.046)。结论利拉鲁肽治疗可能有改善T2DM合并OSAHS患者睡眠呼吸紊乱及糖尿病周围神经病变的作用,对糖尿病肾脏病变�Objective To investigate the effects of glucagon-like peptide-1 analogs on sleep-disordered breathing and diabetic microangiopathy in patients with type 2 diabetes mellitus and obstructive sleep apnea-hypopnea syndrome(OSAHS).Methods A total of 239 patients with T2DM in the Department of Endocrinology and Sleep Center of Henan Provincial People′s Hospital were collected for polysomnography monitoring and diabetic microangiopathy screening from January 2017 to December 2018.A total of 93 patients with T2DM and OSAHS were included,who were diagnosed with diabetic microangiopathy,50 patients treated with liraglutide as the treatment group,and 43 patients treated with conventional hypoglycemic drugs as the control group.After 6-month treatment,changes of body mass index,waist circumference,HbA1c,blood pressure,lipid profile,uric acid,apnea hypopnea index and the improvement of diabetic microangiopathy in the two groups were compared.Student-t test,Rank-sum test or Chi-square test were used for comparison between the two groups.ANCOVA and partial correlation analysis were used to evaluate the correlation between each index and AHI variation value.Multivariate Logistic regression analysis was used to analyze the correlation between liraglutide and the improvement of diabetic microangiopathy.Results After 6-month treatment,compared with control group,BMI,waist circumference,HbA1c,systolic blood pressure,and AHI were decreased more significantly in treatment group[(-1.85±2.46)vs(0.02±0.46)kg/m2,(-3.24±10.34)vs(-0.07±0.88)cm,(-0.83±0.55)%vs(-0.06±0.40)%,(-7.92±14.16)vs(-0.56±16.16)mmHg(1 mmHg=0.133 kPa),(-3.16±3.52)vs(0.5±1.54)time/h,t=2.159-7.703,all P<0.05],diabetic microangiopathy was improved more significantly in treatment group[26.0%(13/50)vs 9.3%(4/43),χ2=4.315,P<0.05].The change in AHI after treatment was positively correlated with changes in BMI,waist circumference and HbA1c(r=0.238,0.232 and 0.317,all P<0.05),and was negatively correlated with age(r=-0.21,P<0.05).After adjusting for age,duration of

关 键 词：糖尿病 2型 睡眠呼吸暂停 阻塞性 糖尿病微血管病变 胰高糖素样肽-1 

分 类 号：R587[医药卫生—内分泌] R76[医药卫生—内科学]