中医痰湿体质与阻塞性睡眠呼吸暂停低通气综合征病变机制探要

目的:从中医体质学角度探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的中西医病变机制的相关性。方法:选择符合西医诊断标准、按中医痰湿体质积分标准分组的痰湿质OSAHS组22例、非痰湿质OSAHS组20例,并选择经多导睡眠仪(PSG)检测正常、具有中医阴阳平和质的正常对照组21例;分析对比三组的呼吸紊乱指数(AHI)、血氧饱和度(SaO2)、嗜睡指数(ESS)、体重指数(BMI)、及血脂、血糖、胰岛素敏感性指数(IAI)、血清瘦素水平(leptin)等指标。结果:痰湿质OSAHS组呈显著高AHI、高ESS、低SaO2及高肥胖频度,与IAI及leptin呈现较高相关性。结论:提示中医痰湿体质是OSAHS的重要致病特质,痰湿质OSAHS患者具有脂、糖代谢紊乱、胰岛素抵抗、及高血清瘦素水平等病理特征,呈典型的打鼾憋气、嗜睡、肥胖等临床表现,并随痰湿体质分值的升高而加重。

On Phlegm-damp Constitution in TCM and Mechanism of Pathological Changes in Obstructive Sleep Apnea Hypopnea Syndrome

Objective: To explore the relationship between phlegm-damp constitution(PDC) in TCM and the mechanism of pathological changes in obstructive sleep apnea hypopnea syndrome(OSAHS).Methods: A total of 42 OSAHS patients diagnosed by western medicine were divided into PDC group(n=22) and non-PDC group(n=20) according to the phlegm-damp constitution integral standard in TCM.Another 21 normal persons with harmonization between yin and yang constitution detected by polysomnography(PSG) served as control group.The indexes of Apnea hypopnea index(AHI),saturation of blood oxygen(SaO_2),somnolent index(SI),body mass index(BMI),insulin sensitivity index(ISI),and levels of serum lipid,glucose and leptin were analyzed and compared among the above groups.Results: In SMC group, AHI and SI were significantly higher and SaO_2 was lower than those in non-SMC group.SMC patients even showed high obesity frequency and high associativity with IAI and leptin.Conclusion: The above indicated that SMC in TCM had a vital pathopoiesis on OSAHS,which leaded to typical severer respiratory disturbance,somnolence,obesity and some other clinical manifestations,and aggravated according to the rising of phlegm-damp constitution score.It also showed saccharometabolic and lipometabolic disturbances,insulin resistance,high serum leptin and some other pathology characteristics.