【作者】 杨景朴；

【导师】 文连姬；

【作者基本信息】 吉林大学 ， 临床医学， 2008， 硕士

【摘要】 目的:探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与代谢综合征(MS)的相关性。观察OSAHS病人血浆脂联素和C反应蛋白(CRP)水平,并分析OSAHS病人脂联素和C反应蛋白的水平与是否合并MS的相关性。方法:通过多导睡眠监测诊断OSAHS,对20例对照组和43例OSAHS病人常规检查身高、体重,空腹血糖(FPG),餐后2小时血糖,血脂,空腹胰岛素(FINS),C反应蛋白水平(CRP)。应用ELASA方法测定血浆中脂联素水平。结果:OSAHS病人与对照组之间体质指数、颈围、腰围不同(P<0.05),重度OSAHS病人白天有明显的嗜睡(P<0.05),重度OSAHS病人甘油三脂(TG)明显升高(P<0.05);中、重度OSAHS病人总胆固醇(CHO)水平高于对照组(P<0.05)。不同程度OSAHS病人血脂紊乱和高血压发生率不同(P<0.05),高血糖的发生率无明显差异,代谢综合征的发生率有统计学差异(P<0.05),重度OSAHS病人,MS的发生率增高(P<0.05)。OSAHS病人脂联素和C反应蛋白水平与对照组不同(P<0.05),中、重度OSAHS病人脂联素的水平低于轻度OSAHS病人,而C反应蛋白水平高于轻度OSAHS病人(P<0.05)。脂联素水平与最低血氧饱和度(LSAT)呈正相关,C反应蛋白水平与呼吸暂停低通气指数(AHI)呈正相关,与最低血氧饱和度(LSAT)呈负相关。OSAHS病人合并代谢综合征者脂联素水平更低,C反应蛋白水平更高(P<0.05)。结论:OSAHS与MS具有相关性, OSAHS病人脂联素水平降低,CRP水平升高, LSAT越低,脂联素水平越低;AHI越高,LSAT越低,CRP水平越高。OSAHS合并MS病人脂联素水平更低,CRP水平更高,OSAHS与MS并存可能增加了心脑血管疾病的风险。更多还原

【Abstract】 Background :The field of sleep apnea and other sleep-disordered breathing syndromes has been among the most rapidly evolving within the discipline of otolaryngology and head and neck surgery. An intrinsic sleep disorder that is often referred for an otolaryngologist’s evaluation is Obstructive sleep apnea hypopnea syndrome (OSAHS). Patients with OSAHS have an apnea-hypopnea index of more than five events per hour of sleep and usually have upper airway resistance and usually have accompanying loud snoring, sleep- disordered breathing, blood oxygen saturation decrease, excessive daytime sleepiness and other symptoms. Currently, OSAHS is considered to be the source of a variety of chronic systemic diseases. Insulin resistance is the pathophysiology foundation of Metabolic syndrome (MS). MS is composed of a series of syndromes such as hypertension, hyperglycemia, hyperlipemia and hyperuricacidemia, which are all risk factors of cardiovascular disease. MS is the most principal factor in the development of cardiovascular disease. More and more scholars have paid attention to the relationship between MS and OSAHS. Adiponectin levels and C-reactive protein (CRP) levels in serum are closely related to the metabolic syndrome. Adiponectin is one of the important regulatory factors in the regulation network of lipids metabolism and blood sugar homeostasis. It can reduce the level of blood sugar and blood fat and strengthen insulin resistance, anti-inflammatory and antagonistic role in atherosclerosis sclerosis. CRP level rising in serum can be used to assess the occurrence of acute complications and prognosis in atherosclerosis. Therefore, we can speculate that OSAHS may affect the adiponectin levels and CRP levels and the determination of adiponectin and CRP level may evaluate the risk of cardiovascular disease. In our study, we compared blood pressure, fasting serum glucose, blood fat, adiponectin, CRP in both OSAHS group and control group ,then discussed whether the obstructive sleep apnea hypopnea syndrome (OSAHS) was associated with the metabolic syndrome. Furthermore, we detected adiponectin levels and CRP levels in serum of OSAHS patients and analyzed whether their levels were relative to combined with MS.Methods: According to apnea-hypopnea index (AHI), the OSAHS patients were divided into mild, moderate and severe groups: severe OSA (AHI>40, 21 males), moderate OSA (20<AHI< or =40, 15 males), mild OSA (5<AHI< or =20, 7 males). And we selected 20 simple snorers as control group. There was no significant difference of age in each group. All patients were male and all patients had been detected MS-associated parameters such as fasting blood glucose(FBG), fasting plasma insulin(FINS), triglyceride(TG), high density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol(LDL-C), the serum levels of C-reactive protein (CRP), and serum adiponectin levels, body mass index(BMI),waist circumference, neck circumference and blood pressure(BP). Polysomnography was examined during sleep, Polysomnography parameters such an AHI,SaO2,were detected.Results: Patients with OSAHS had higher BMI, waist circumference, neck circumference (P<0.05). The patients of severe group were significantly sleepy compared to other groups.(P<0.05). TG and CHO in each OSAHS group were different.(P<0.05). There was no significant difference among the mild, moderate and severe group in HDL-C (P>0.05). The severe group of OSAHS had higher TG levels.(P<0.05). CHO levels in severe and moderate group of OSAHS were different with other groups.(P<0.05)Patients with OSAHS suffered from hypertension and dyslipidemia. There was also significant difference among the mild, moderate and severe group with the development of OSAHS (P<0.05). Fasting blood glucose had no significant difference. The incidence of complicating the metabolic syndrome in patients with different pathogenetic condition had statistical differences(P<0.05). The complication of the metabolic syndrome in the severe group of OSAHS was much higher than that in other groups(P<0.05). It was found that the serum adiponectin levels were lower and CRP levels were higher in the subjects with OSAHS than that in those without OSAHS. Multiple stepwise regression analysis showed that the lowest arterial oxygen saturation was an independent risk factor resulting in the decrease of serum adiponectin levels while BMI and The apnea-hypopnea index value during sleep did not. The apnea-hypopnea index value was an independent risk factor resulting in the increase of serum CRP levels, while BMI and the lowest arterial oxygen saturation during sleep did not. Furthermore, among the patients with OSAHS, the serum adiponectin levels were lower and the CRP levels were higher in moderate and severe groups of OSAHS (P<0.05) , and the serum adiponectin levels were lower and the CRP level were higher with the complication of the metabolic syndrome than in those without metabolic syndrome (P <0.05).Conclusions: We investigated whether the components of metabolic syndrome were associated with OSAHS in nonobese patients. OSAHS is associated with the components of metabolic syndrome and its overall prevalence. The serum adiponectin levels were lower and the CRP levels were higher with the complication of the metabolic syndrome in OSAHS . Therefore, the complication of metabolic syndrome may become an additive cardiovascular risk factor in subjects with OSAHS.更多还原