不同严重程度的阻塞性睡眠呼吸暂停低通气综合征病人血清脂联素,胰高血糖素样肽-1水平变化  

Changes in level of plasma APN and GLP-1 in patients with different severity of obstructive sleep apnea hypopnea syndrome

作　　者：刘盈[1] 孙剑芳[2] LIU Ying;SUN Jianfang(Department of Emergency,The First Affiliated Hospital of Nanchang University,Nanchang,330006;Department of Rheumatology,The First Affiliated Hospital of Gannan Medical College,Ganzhou,341000)

机构地区：[1]江西省南昌大学第一附属医院急诊科,南昌330006 [2]江西省赣南医学院第一附属医院风湿免疫科,赣州341000

出　　处：《江西医药》2021年第10期1583-1586,共4页Jiangxi Medical Journal

基　　金：江西省卫生健康委员会科技项目,编号20185077。

摘　　要：目的探讨脂联素(APN)及胰高血糖素样肽-1(GLP-1)在不同严重程度的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者中的变化。方法纳入南昌大学第一附属医院呼吸内科睡眠监测室OSAHS病人100例,根据多导睡眠监测(PSG)以呼吸暂停低通气指数(AHI)为分组依据分为3组:5≤AHI<30的OSAHS患者(轻中度组)32例,男23例,女9例,平均年龄41.2±12.6岁;30≤AHI<60的OSAHS患者(重度组)32例,男30例,女2例,平均年龄42.7±11.4岁;AHI≥60的OSAHS患者(极重度组)36例,男32例,女4例,平均年龄42.2±8.0岁。比较三组间一般临床资料、生化指标,血APN、GLP-1浓度;采用Pearson相关性分析法、多元线性逐步回归分析法分析APN、GLP-1与各因素之间的相关性。结果OSAHS极重和重度组APN水平均显著低于OSAHS轻中组(P<0.01),OSAHS极重和重度组APN水平差异无统计学意义(P>0.05);OSAHS轻中组、极重组、重度组三组间GLP-1水平差异无统计学意义(P>0.05)。Pearson相关性分析结果显示,血清APN与体质指数(BMI)(r=-0.223)、颈围(r=-0.325)、腰围(r=-0.324)、AHI(r=-0.265)、总胆固醇(TC)(r=-0.201)、甘油三酯(TG)(r=-0.205)呈显著负相关;血清GLP-1与BMI(r=0.433)、颈围(r=0.273)、腰围(r=0.439)、收缩压(SBP)(r=0.295)、舒张压(DBP)(r=0.284)、AHI(r=0.198)、糖化血红蛋白(HbA1c)(r=0.163)、TC(r=0.194)、TG(r=0.388)和LDL-C(r=0.189)均呈显著正相关;多元线性逐步回归分析结果显示,AHI、腰围是APN的独立影响因素(R_(2)=0.275),最低血氧饱和度(SaO_(2)min)是GLP-1的独立影响因素(R_(2)=0.139)。结论OSAHS患者血清APN、GLP-1水平与OSAHS严重程度相关,间歇性缺氧可能通过影响OSAHS患者体内血清APN、GLP-1水平导致体内的血糖代谢紊乱。Objective The aim of the present study was to investigate the expression of APN and GLP-1 in patients with different severity of obstructive sleep apnea hypopnea syndrome(OSAHS).Methods A total of 100 outpatients were recruited in pneumology department at the First Affiliated Hospital of Nanchang University,and were divided into mild-to-moderate OSAHS group(5≤AHI<30,N=32,mean age 41.2±12.6 years)and severe OSAHS group(30≤AHI<60,N=32,mean age 42.7±11.4 years),extremely severe OSAHS group(AHI≥60,N=36,mean age 42.2±8.0 years).Venous blood was collected,plasma APN and GLP-1 was measured by enzyme linked immunosorbent assay and compared,respectively.Results The APN levels in extremely severe OSAHS and severe OSAHS groups were significantly lower than that in mild-medium OSAHS group(P<0.01),there was no statistical significance in the APN level between the extremely severe and severe OSAHS groups(P>0.05).There was no statistically significant difference in GLP-1 levels among the mild-medium OSAHS group,severe OSAHS groups and extremely severe OSAHS groups(P>0.05).Pearson analysis showed that serum APN levels in patients with OSAHS was negatively correlated with BMI,neck circumference,waist circumference,AHI,TC and TG.Serum GLP-1 levels in patients with OSAHS was significantly positively associated with BMI,neck circumference,waist circumference,SBP,DBP,AHI,HbA1c,TC,TG and LDL-C.Multiple linear stepwise regression analysis showed that AHI and waist circumference were independently associated with APN.SaO_(2)min were independently associated with GLP-1.Conclusion Serum APN and GLP-1 levels in OSAHS patients are related to the severity of OSAHS.Intermittent hypoxia may affect the serum APN and GLP-1 secretion levels in OSAHS,leading to disorders of blood glucose metabolism in OSAHS patients.

关 键 词：阻塞性睡眠呼吸暂停低通气综合征 脂联素 胰高血糖素样肽-1 

分 类 号：R766[医药卫生—耳鼻咽喉科]