阻塞性睡眠呼吸暂停低通气综合征与肝损伤的关联及性别差异分析  

Association and gender difference analysis of obstructive sleep apnea hypopnea syndrome and liver injury

作　　者：陈理达 黄杰凤 陈公平[2] 曾爱明 陈梦雪 陈梦岚 林其昌[2] Chen Lida;Huang Jiefeng;Chen Gongping;Zeng Aiming;Chen Mengxue;Chen Menglan;Lin Qichang(Department of Respiratory and Critical Care Medicine,Zhangzhou Affiliated Hospital of Fujian Medical University,Zhangzhou 363000,China;Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Fujian Medical University,Fuzhou 350000,China)

机构地区：[1]福建医科大学附属漳州市医院呼吸与危重症医学科,漳州363000 [2]福建医科大学附属第一医院呼吸与危重症医学科,福州350000

出　　处：《中华医学杂志》2022年第8期550-554,共5页National Medical Journal of China

基　　金：国家自然科学基金 (81900088,81870074,81900090)。

摘　　要：目的:探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与肝损伤的关联及性别差异。方法:将2015年11月至2019年9月在福建医科大学附属第一医院和漳州市医院就诊的974例OSAHS患者(轻中度444例,重度530例)和111例单纯性鼾症患者纳入研究。采用自制问卷通过面对面调查获取患者基本情况,对患者进行体格检查、睡眠监测和血液生化及肝功能指标检测。采用多因素logistic回归模型分析OSAHS与肝损伤的关联情况及性别差异。结果:研究对象年龄为(50±14)岁,其中男性841例(77.5%)。3组总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、ALT/AST、γ-谷氨酰转肽酶(GGT)、ALT升高比例、AST升高比例、肝损伤比例差异均有统计学意义(均 P<0.05);总胆红素和碱性磷酸酶差异均无统计学意义(均 P>0.05)。调整混杂因素后,重度OSAHS与肝损伤呈正向关联[ OR(95% CI):2.25(1.22~4.14)];按性别分组的亚组分析显示:调整混杂因素后,男性重度OSAHS与肝损伤呈正向关联[ OR(95% CI):2.20(1.04~4.65)];女性OSAHS与肝损伤无关联,轻中度、重度OSAHS的 OR值(95% CI)分别为1.56(0.52~4.71)、2.07(0.64~6.75)。 结论:男性重度OSAHS与肝损伤呈正向关联,女性OSAHS与肝损伤无关联。Objective To investigate the correlation and sex difference between obstructive sleep apnea hypopnea syndrome(OSAHS)and liver injury.Methods A total of 974 OSAHS patients(444 cases of mild to moderate,530 cases of severe)and 111 cases of simple snoring in the First Affiliated Hospital of Fujian Medical University and Zhangzhou Municipal Hospital from November 2015 to September 2019 were included in the study.The basic information of the patients was obtained through face-to-face survey with self-made questionnaire,physical examination,sleep monitoring and blood biochemical and liver function index detection were carried out among the included subjects.Multiple logistic regression model was used to analyze the correlation between OSAHS and liver injury and the gender differences.Results The subjects were(50±14)years old,including 841 males(77.5%).Statistically significant differences in total cholesterol(TC),triglycerides(TG),low density lipoprotein-cholesterol(LDL-C),high density lipoprotein-cholesterol(HDL-C),fasting blood glucose,alamine aminotransferase(ALT),aspartate aminotransferase(AST),ALT/AST,gamma glutamyltransferase(GGT),the rate of elevated ALT,AST and liver injury were observed among the three groups(all P values<0.05).There was no significant difference in total bilirubin and ALP among all groups(all P values>0.05).Multivariate logistic regression showed that after adjusting for confounding factors,severe OSAHS was positively correlated with liver injury[OR(95%CI):2.25(1.22-4.14)].Subgroup analysis by gender showed that severe OSAHS was positively correlated with liver injury in males[OR(95%CI):2.20(1.04-4.65)],but not in females,mild to moderate OSAHS[OR(95%CI):1.56(0.52-4.71)]or severe OSAHS[OR(95%CI):2.07(0.64-6.75)],after adjusting for confounding factors.Conclusion Severe OSAHS is positively correlated with liver injury in males,while female OSAHS is not associated with liver injury.

关 键 词：睡眠呼吸暂停 阻塞性 肝疾病 性别因素 转氨酶类 横断面研究 

分 类 号：R766[医药卫生—耳鼻咽喉科] R575[医药卫生—临床医学]