肥胖患者OSAHS严重程度与血清肝酶、血脂及同型半胱氨酸水平的相关性研究  

Study on the correlation between the severity of OSAHS and the levels of serum liver enzymes,blood lipids and homocysteine in obese patients

作　　者：刘言卫 徐岩岩 齐勇 陈皖京 LIU Yanwei;XU Yanyan;QI Yong;CHEN Wanjing(Department of General Surgery,Second Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230601,China)

机构地区：[1]安徽医科大学第二附属医院普外科,安徽合肥230601

出　　处：《临床肺科杂志》2025年第3期354-358,365,共6页Journal of Clinical Pulmonary Medicine

摘　　要：目的研究肥胖患者合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)对心率、血清肝酶、血脂及同型半胱氨酸水平的影响。方法回顾性分析2020年5月至2021年9月就诊于安徽医科大学第二附属医院减重代谢外科的161例肥胖症患者的临床资料、多导睡眠监测结果及血生化指标,根据睡眠呼吸暂停低通气指数(AHI)将患者分为单纯性肥胖组(A组,AHI<5次/h,共59例)、肥胖合并轻、中度OSAHS组(B组,AHI 5~30次/h,共57例)、肥胖合并重度OSAHS组(C组,AHI>30次/h,共45例),分析OSAHS严重程度对肥胖患者心率、血清谷丙转氨酶(ALT)、谷草转氨酶(AST)、直接胆红素(DBIL)、间接胆红素(IBIL)、碱性磷酸酶(ALP)、γ-谷氨酰转肽酶(γ-GT)、总胆固醇(CHO)、甘油三酯(TG)以及同型半胱氨酸(Hcy)等水平的影响及相关性,同时采用多因素Logistic回归分析肥胖患者OSAHS发生的危险因素。结果多导睡眠监测结果显示,随着患者OSAHS程度的加重,A、B、C组平均心率(HR)逐渐加快(F=3.274,P=0.040)、平均指脉氧饱和度(MSpO_(2))及最低指脉氧饱和度(LSpO_(2))逐渐降低(MSpO_(2):F=40.332,P<0.001;LSpO_(2):F=41.947,P<0.001),差异均具有统计学意义;血生化结果显示,血清ALT、AST、DBIL以及IBIL水平在A、B、C三组间无统计学差异(P>0.05);而ALP(H=13.292,P=0.001)、γ-GT(H=21.783,P<0.001)、CHO(H=9.323,P=0.009)、TG(H=7.818,P=0.020)以及Hcy(H=9.024,P=0.011)随OSAHS程度的加重呈上升趋势,差异均具有统计学意义;多因素分析结果显示,年龄、BMI、γ-GT、Hcy是肥胖患者发生OSAHS的独立危险因素。结论肥胖合并OSAHS患者MSpO_(2)和LSpO_(2)显著降低,血清ALP、γ-GT、CHO、TG、Hcy水平升高,推测减重手术在减轻患者体重的同时,有望改善OSAHS严重程度,使MSpO_(2)和LSpO_(2)恢复到正常水平,并改善血清ALP、γ-GT、血脂及同型半胱氨酸水平。Objective To study the effects of obstructive sleep apnea-hypopnea syndrome(OSAHS)on heart rate,serum liver enzymes,blood lipids,and homocysteine levels in obesity patients.Methods A total of 161 patients with obesity admitted to the Department of Bariatric and Metabolic Surgery,Second Affiliated Hospital of Anhui Medical University from May 2020 to September 2021 were enrolled.The clinical data,polysomngraphy results,and blood biochemical indexes were retrospectively analyzed.According to the apnea hypopnea index(AHI),the patients were divided into three groups:simple obesity group(group A,AHI<5,n=59),obesity combined with mild or moderate OSAHS group(group B,AHI 5-30,n=57),obesity combined with severe OSAHS group(group C,AHI>30,n=45).The effects of OSAHS severity on heart rate,serum alanine aminotransferase(ALT),aspartate aminotransferase(AST),direct bilirubin(DBIL),indirect bilirubin(IBIL),alkaline phosphatase(ALP),γ-glutamyl transpeptidase(γ-GT),cholesterol(CHO),triglyceride(TG),and homocysteine(Hcy)in the obesity patients were analyzed,and the multivariate logistic regression was applied to analyze the risk factors of OSAHS in obese patients.Results The results of polysomnography showed that with the aggravation of OSAHS,the average heart rate of groups A,B and C gradually increased(F=3.274,P=0.040),while the mean finger pulse oxygen saturation(MSpO_(2))and the lowest finger pulse oxygen saturation(LSpO_(2))gradually decreased(MSpO_(2):F=40.332,P<0.001;LSpO_(2):F=41.947,P<0.001),the differences were statistically significant.The results of blood biochemistry showed that the levels of serum ALT,AST,DBIL and IBIL were not significantly different among the three groups(P>0.05).However,ALP(H=13.292,P=0.001),γ-GT(H=21.783,P<0.001),CHO(H=9.323,P=0.009),TG(H=7.818,P=0.020)and Hcy(H=9.024,P=0.001)increased with the severity of OSAHS,and the differences were statistically significant.Multivariate analysis showed that age,BMI,γ-GT and Hcy were independent risk factors for OSAHS in obese patients.Conclusion In obes

关 键 词：肥胖症 阻塞性睡眠呼吸暂停低通气综合征 睡眠呼吸暂停低通气指数 Γ-谷氨酰转肽酶 同型半胱氨酸 

分 类 号：R766[医药卫生—耳鼻咽喉科] R589.2[医药卫生—临床医学]