阻塞性睡眠呼吸暂停低通气综合征与代谢相关脂肪性肝病的发生及其危险因素的研究  

Study of the occurrence of metabolic dysfunction-associated fatty liver disease in obstructive sleep apnea hypopnea syndrome and its risk factors

作　　者：郭燕兰 张代义[2] 徐珅杰 张敏杰 李洁[1] Guo Yanlan;Zhang Daiyi;Xu Shenjie;Zhang Minjie;Li Jie(Department of General Medicine the First Affiliated Hospital of Soochow University,Suzhou 215006,China;Health Management Center the First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院全科医学科,苏州215006 [2]苏州大学附属第一医院健康管理中心,苏州215006

出　　处：《中华内科杂志》2025年第2期128-133,共6页Chinese Journal of Internal Medicine

基　　金：苏州市科技计划项目(SKY2023048);苏州市临床重点病种诊疗技术专项项目(LCZX202305)。

摘　　要：目的分析阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的代谢相关脂肪性肝病(MAFLD)的发生及相关炎症指标情况,探索发生MAFLD的危险因素。方法横断面研究。选取2022年1月至2024年10月苏州大学附属第一医院就诊的睡眠障碍患者172例,其中非OSAHS患者38例、轻度OSAHS患者53例、中度OSAHS患者37例及重度OSAHS患者44例。从代谢相关脂肪肝(MAFL)、肝酶升高、肝纤维化这三方面综合分析判断MAFLD的发生,比较四组间的MAFLD情况及相关炎症指标水平,采用二元logistic回归分析OSAHS发生MAFLD的危险因素。结果四组间的MAFL患病率、肝酶升高比例、白细胞介素6、肿瘤坏死因子-α(TNF-α)差异均有统计学意义(均P<0.05)。四组间的纤维化-4指数、C反应蛋白差异无统计学意义(均P>0.05)。二元logistic回归分析示体重指数(BMI)、甘油三酯、最长呼吸暂停时间、TNF-α是MAFL的危险因素(P<0.05),BMI、葡萄糖、呼吸暂停低通气指数是肝酶升高的危险因素(P<0.05)。结论OSAHS与MAFLD密切相关,且OSAHS参与MAFLD的发生发展可能与肥胖、脂质代谢紊乱、胰岛素抵抗、炎症反应和间歇性缺氧等机制相关。ObjectiveTo analyze the occurrence of metabolic dysfunction-associated fatty liver disease(MAFLD)and related inflammatory indicators in obstructive sleep apnea hypopnea syndrome(OSAHS)and explore the risk factors of MAFLD.MethodsA cross-sectional study.From January 2022 to October 2024,172 patients with sleep disorders were enrolled in the First Affiliated Hospital of Soochow University,including 38 patients with non-OSAHS,53 patients with mild OSAHS,37 patients with moderate OSAHS,and 44 patients with severe OSAHS.The occurrence of MAFLD was comprehensively judged from three aspects:metabolic dysfunction-associated fatty liver(MAFL),elevated liver enzymes,and liver fibrosis.The situation of MAFLD and the level of related inflammatory markers were compared among the four groups.Binary logistic regression was used to analyze the risk factors for MAFLD in OSAHS.ResultsThere were significant differences in the prevalence of MAFL,the percentage of elevated liver enzymes,and interleukin-6 and tumor necrosis factor-alpha levels among the four groups(P<0.05).The differences of fibrosis-4 index and C-reactive protein among the four groups were not statistically significant(P>0.05).Binary logistic regression showed that BMI,triglycerides,longest time of sleep apnea and tumor necrosis factor-alpha were the risk factors for MAFL(P<0.05).BMI,glucose,and apnea-hypopnea index were the risk factors for elevated liver enzymes(P<0.05).ConclusionsOSAHS is strongly associated with MAFLD,and the involvement of OSAHS in the occurrence and development of MAFLD may be related to obesity,lipid metabolism disorders,insulin resistance,inflammatory responses,and intermittent hypoxia.

关 键 词：睡眠呼吸暂停 阻塞性 脂肪肝 炎症 

分 类 号：R766[医药卫生—耳鼻咽喉科] R575.5[医药卫生—临床医学]