平衡肥胖因素后阻塞性睡眠呼吸暂停对甲状腺激素影响的初步探索  

Preliminary exploration of the impact of obstructive sleep apnea on thyroid hormones after balancing obesity factors

作　　者：黄玉阳 欧阳松云[1] 代丽萍 陈瑞英[1] 赵春玲[1] 苏皎 房怡菲 HUANG Yuyang;OUYANG Songyun;DAI Liping;CHEN Ruiying;ZHAO Chunling;SU Jiao;FANG Yifei(Department of Respiratory,Critical Care and Sleep Medicine,The First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China;Henan Institute of Medical and Pharmaceutical Sciences,Zhengzhou University,Zhengzhou,Henan 450052,China)

机构地区：[1]郑州大学第一附属医院呼吸与危重症睡眠医学科,河南郑州450052 [2]郑州大学河南省医药科学研究院,河南郑州450052

出　　处：《临床肺科杂志》2024年第7期973-977,989,共6页Journal of Clinical Pulmonary Medicine

基　　金：国家自然科学基金(No.U1804195)。

摘　　要：目的基于倾向性得分匹配(propensity score matching,PSM)平衡肥胖干扰后探索阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)对甲状腺激素的影响。方法根据多导睡眠监测结果,选取2017年1月至2021年12月于郑州大学第一附属医院就诊的582例OSA患者。根据既往甲状腺疾病史及TSH、FT3、FT4水平将研究对象分为四个亚组:A组(包含所有甲状腺激素异常患者,n=582),B组(剔除甲状腺功能减退、甲状腺功能亢进患者,n=561),C组(剔除甲状腺功能减退、甲状腺功能亢进、亚临床甲状腺功能异常患者,n=538),D组(剔除所有甲状腺激素异常患者,n=515)。各亚组依据呼吸暂停低通气指数(apnea-hypopnea index,AHI)水平分为轻中度OSA组(AHI≤30次/h)和重度OSA组(AHI>30次/h)。以AHI分组作为PSM的因变量,以性别、年龄、身体质量指数(body mass index,BMI)作为PSM的自变量对各组进行PSM。采用单因素和Logistic回归分析各组PSM前后OSA严重程度对甲状腺激素的影响。结果BMI水平在PSM前A、B、C、D亚组中均为重度OSA组高于轻中度OSA组(P<0.05),在PSM后均没有统计学差异(P>0.05)。FT3水平在B、C、D亚组PSM前后单因素和Logistic回归分析中为重度OSA组高于轻中度OSA组(P<0.05),在A亚组中仅PSM前升高(P<0.05)。FT4、TSH水平在各亚组PSM前后差异均没有统计学意义(P>0.05)。结论随着OSA患者病情加重,可以引起FT3水平升高,但未能引起FT4和TSH水平变化。Objective To explore the effect of obstructive sleep apnea(OSA)on thyroid hormones after balancing obesity disturbance based on propensity score matching(PSM).Methods According to the results of polysomnography,582 patients with OSA were selected from the first affiliated Hospital of Zhengzhou University from January 2017 to December 2021.The study subjects were divided into four subgroups based on history of previous thyroid disease and TSH,FT3,and FT4 levels:group A(including all patients with thyroid hormone abnormalities,n=582),group B(excluding patients with hypothyroidism and hyperthyroidism,n=561),group C(excluding patients with hypothyroidism,hyperthyroidism,and subclinical thyroid abnormalities,n=538),group D(excluding all patients with thyroid hormone abnormalities,n=515).The subgroups were categorized into mild-moderate OSA group(AHI≤30 times/h)and severe OSA group(AHI>30 times/h)based on the level of apnea-hypopnea index(AHI).AHI grouping was used as the dependent variable for PSM,and gender,age,and body mass index(BMI)were used as independent variables for PSM for each group.The effect of OSA severity on thyroid hormones before and after PSM was analyzed in each group using univariate and logistic regression.Results BMI levels in subgroups A,B,C,and D before PSM were higher in the severe OSA group than in the mild-moderate OSA group(P<0.05),but there was no statistical difference after PSM(P>0.05).In the univariate and Logistic regression analysis before and after PSM in subgroups B,C,and D,the level of FT3 in the severe OSA group was higher than that in the mild-moderate OSA group(P<0.05),and only increased before PSM in subgroup A(P<0.05).There were no significant differences in FT4 and TSH levels before and after PSM among subgroups(P>0.05).Conclusion With the aggravation of OSA patients,FT3 levels can be increased,but FT4 and TSH levels cannot be changed.

关 键 词：阻塞性睡眠呼吸暂停 甲状腺激素 肥胖 倾向性得分匹配 

分 类 号：R766[医药卫生—耳鼻咽喉科]