经鼻持续气道内正压通气治疗对阻塞性睡眠呼吸暂停低通气综合征瘦素水平及代谢紊乱的影响  

Effects of Nasal Continuous Positive Airway Pressure on Serum Leptin Concentration and the Metabolic Parameters in Obstructive Sleep Apnea Hypopnea Syndrome

作　　者：黄蓉[1] 黄席珍[1] 王惠阁[1] 黎明 肖毅[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院呼吸科,北京100730 [2]Department of Endocrinology, PUMC Hospital, CAMS and PUMC, Beijing

出　　处：《中国医学科学院学报》2004年第2期168-171,共4页Acta Academiae Medicinae Sinicae

摘　　要：目的 评价经鼻持续气道内正压通气 (nasal continuous positive airway pressure nCPAP)治疗对阻塞性睡眠呼吸暂停低通气综合征 (obstructive sleep apnea/hypopnea syndrom e OSAH S)瘦素水平和代谢紊乱的影响,探讨瘦素水平在 OSAH S 发病中的作用。方法 测定 OSAH S 患者在 nCPAP 一夜治疗 (18例)和长期治疗 (8例,治疗时间 7.5个月)前后的血清瘦素浓度,对比治疗前后部分代谢参数的变化。结果 nCPAP 一夜治疗后,血清瘦素水平下降 (8.47±0.62)μg/L vs (7.32±0.64)μg/L P =0.022,其余参数未见明显变化 (P >0.05);血清瘦素水平在nCPAP 长期治疗后明显下降并独立于体重指数 (body m ass index BM I) 8.35±0.83 μg/L vs (6.05±0.78)μg/LP =0.036;血清空腹血糖 FBG 和空腹真胰岛素 TI 均在 nCPAP 长期治疗后明显下降 (P 值均为 0.036),但甘油三酯 TG 和胆固醇 Chol 未见明显变化。结论 nCPAP 一夜和长期治疗能降低 OSAH S 的瘦素水平并独立于 BM I,OSAH S 可能对血清瘦素水平具有独立的作用;nCPAP 长期治疗可改善 OSAH S 的糖代谢及胰岛素抵抗。Objective To evaluate the effects of nasal continuous positive airway pressure(nCPAP)on serum leptin concentration and the metabolic parameters in patients with obstructive sleep apnea/ hypopnea syndrome(OSAHS). Methods Serum leptin levels and true insulin(TI)levels were measured before and after one night nCPAP therapy in 18 patients. Eight patients received regular nCPAP treatment and had no change of body weight(BMI change ≤ 1.5 kg/m2 from baseline)were recruited to the reassessment study 7.5 months after therapy. Results After one night use of nCPAP, there was a significant decrease in serum leptin[(8.47 ± 0.62)μg/L vs(7.32 ± 0.64)μg/L, P = 0.022]without change in other parameters. After 7.5 months of nCPAP treatment, serum leptin levels continued to decrease significantly without changes in BMIwithout change in other parameters. After 7.5 months of nCPAP treatment, serum leptin levels continued to decrease significantly without changes in BMI[(8.35 ± 0.83)μg/L vs(6.05 ± 0.78)μg/L;P = 0.036), and fast blood glucose(FBG)and true insulin(TI)also decreased significantly(P = 0.036)in OSAHS patients. However, triglyceral(TG)and cholesterol(Chol)maintained the pretreatment level(P > 0.05). Conclusions OSAHS may have significant effects on the serum leptin levels and the correction of sleep disordered breathing by nCPAP can reduce the serum leptin levels. Decrease of leptin was independent of BMI change. The glucose metabolic disturbance and insulin resistance in OSAHS were improved after 7.5 months of nCPAP treatment.

关 键 词：经鼻持续气道内正压 阻塞性睡眠呼吸暂停低通气综合征 瘦素 

分 类 号：R563.9[医药卫生—呼吸系统]