艾塞那肽对2型糖尿病合并阻塞性睡眠呼吸暂停低通气综合征患者缺氧状态的影响  

Effect of exenatide on hypoxia status of patients with type 2 diabetes mellitus complicated with obstructive sleep apnea hypopnea syndrome

作　　者：陈艳[1] 王小清 郝海荣[1] 柏凤[1] 张勇[1] 程亮[1] 胡文[1] CHEN Yan;WANG Xiaoqing;HAO Hairong;BAI Feng;ZHANG Yong;CHENG Liang;HU Wen(Department of Endocrinology,Huaian Second People's Hospital,Huaian,Jiangsu,223002)

机构地区：[1]江苏省淮安市第二人民医院内分泌科,江苏淮安223002

出　　处：《实用临床医药杂志》2020年第10期77-81,共5页Journal of Clinical Medicine in Practice

基　　金：江苏省淮安市科技计划专项基金(HAS201611-4)。

摘　　要：目的探讨艾塞那肽对2型糖尿病合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者缺氧状态的影响。方法选取2型糖尿病合并OSAHS患者43例,随机分为A组21例(使用预混胰岛素治疗)、B组22例(使用艾塞那肽治疗)。比较2组患者治疗前后代谢指标和缺氧指数变化情况。结果B组有2例患者因严重胃肠道反应脱落。与治疗前相比,2组治疗后糖化血红蛋白(HbA1C)、餐后2 h血糖(2 h PG)、胰岛素抵抗指数(HOMA-IR)显著下降,A组空腹血糖(FPG)显著下降(P<0.05)。与A组比较,B组HOMA-IR较低,FPG较高,差异有统计学意义(P<0.05)。与治疗前比较,B组患者治疗后收缩压(SBP)、腰围(WC)、体质量指数(BMI)、体质量、肝脏脂肪含量(LFC)、低密度脂蛋白胆固醇(LDL-C)显著下降,且与A组比较有显著差异(P<0.05)。2组治疗前缺氧指标均无显著差异(P>0.05)。B组治疗后氧减指数(ODI)显著下降,夜间最低血氧饱和度(LSpO 2)显著升高(P<0.05),且B组LSpO 2显著高于A组(P<0.05)。矫正性别、年龄后,B组患者初诊时临床代谢指标与缺氧指标变化的偏相关分析结果显示,初诊的WC与△ODI呈显著正相关(P<0.05),BMI、血肌酐(SCr)与△LSpO 2呈显著正相关(P<0.05),估算肾小球滤过率(eGFR)与△LSpO 2呈显著负相关(P<0.05)。结论单用艾塞那肽治疗可以改善2型糖尿病合并OSAHS患者的血糖、血脂、胰岛素抵抗、ODI和LSpO 2。Objective To explore the effect of exenatide on hypoxia status of patients with type 2 diabetes mellitus complicated with obstructive sleep apnea hypopnea syndrome(OSAHS).Methods Forty-three patients with type 2 diabetes mellitus complicated with OSAHS were selected and randomly divided into group A(n=21)and group B(n=22).Group A was treated with premixed insulin,and group B was treated with exenatide.The changes of metabolic indexes and hypoxia indexes before and after treatment were compared between the two groups.Results In group B,two cases were removed due to severe gastrointestinal reactions.Compared with those before treatment,the levels of glycosylated hemoglobin(HbA1C),2-hour postprandial blood glucose(2 h PG)and insulin resistance index(HOMA-IR)after treatment in both group were significantly lower,and fasting blood glucose(FPG)in group A was significantly lower(P<0.05).Compared with group A,HOMA-IR was significantly lower and FPG was significantly higher in group B(P<0.05).Compared with before treatment,systolic blood pressure(SBP),waist circumference(WC),body mass index(BMI),body mass,liver fat content(LFC)and low density lipoprotein cholesterol(LDL-C) decreased significantly after treatment in group B, and there were significant differences between groupB and group A ( P <0.05). There were no significant differences in hypoxia indexes before treatment between the two groups ( P >0.05). After treatment, oxygen reduction index (ODI) decreased significantly and the lowest oxygen saturation at night (LSpO 2) increased significantly in group B ( P <0.05), and LSpO 2 in group B was significantly higher than that in group A ( P < 0.05) . After correction of gender and age, the partial correlation analysis of clinical metabolic indexes and hypoxia indexes at first visit in group B showed that WC was positively correlated with △ODI ( P <0.05), BMI, serum creatinine (SCR) was positively correlated with △LSpO 2 ( P < 0.05) , and estimated glomerular filtration rate (eGFR) was negatively correlated with △L

关 键 词：阻塞性睡眠呼吸暂停低通气综合征 2型糖尿病 艾塞那肽 胰岛素 氧减指数 夜间最低血氧饱和度 估算肾小球滤过率 

分 类 号：R587.1[医药卫生—内分泌]