瘦素在阻塞性睡眠呼吸暂停低通气综合征合并代谢综合征中的变化及意义

目的探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）及其合并代谢综合征（MS）患者血清瘦素（Lep）的变化及意义。方法OSAHS男性患者70例，分为单纯OSAHS组40例及OSAHS合并MS组30例，40例年龄、体质量指数（BMI）与OSAHS患者相匹配者为对照组，测量身高、体质量、颈围（NC）、腰围、臀围等，检测各组血清空腹血糖（FBG）、血清瘦素（Lep）、空腹真胰岛素（TI）水平、三酰甘油（TG）、胆固醇（Ch01），采用稳态模型评估法（nOMA）评价并计算胰岛素抵抗指数（HOMA—IR）。结果①OSAHS组与OSAHS组合并MS组患者血清Lep水平高于对照组（P〈0．05，P〈0．01），且OSAHS合并Ms纽血清Lep高于OSAttS组（P〈0．01），OSAHS纽亚组间，中、重度组高于轻度组（P〈0．05，P〈0．01）。②血清Lep水平与其他指标的Spearman’s相关分析：OSAHS组血清Lep水平与AHI、HOMA—IR、BMI呈正相关（P〈0．01），与最低氧饱和度（LSpO2）呈负相关（P〈0．01）。OS—AHS合并MS组血清Lep水平与呼吸暂停低通气指数（AHI）、HOMA—IR、BMI、NC、腰臀比（WHR）、收缩压（SBP）、舒张压（DBP）、FBG、TG等呈显著正相关（P〈0．001），与最低氧饱和度（LSpO2）呈负相关（P〈0．001），多元线性逐步回归分析显示：BMI（P=0．003）、HOMA—IR（P=0．024）、AHI（P=0．036）是OSAHS组血清瘦素水平的独立相关因素。③OSAHS组与BMI、年龄相匹配的对照组相比醒后血压，尤其是舒张压要高于对照组（P〈0．01）；各组血压与各指标进行Spearman’s相关分析示：与BMI、AHI、Lep正相关；多元Logistic回归分析表明：BMI（P=0．031）及Lep水平（P=0．064）是高血压的独立相关因素。结论OSAHS较单纯肥胖者有更高的瘦素水平，与OSAHS进展有关，高瘦素血症并存胰岛素抵抗可能参与了OSAHS合并MS的病理生理过程。

Change and significance of leptin in obstructive sleep apnea hypopnea with metabolic syndromes

Objective To investigate the changes and implications of serum leptin levels in obstructive sleep apnea hypopnea syndrome（OSAHS） and OSAHS with metabolic syndrome （MS）. Methods Seventy OSAHS men were divided into two sub - groups ： OSAHS group （ n = 40） and OSAHS with MS group （n = 30 ）. Forty non - OSAHS men were matched with OSAHS group for body mass index （BMI） and age. Measured the height, weight, neck circumference（ NC）, waist, hip, fasting blood glucose （ FBG）, leptin, true insulin （ TI ）, triglyceral （TG） and cholesterol （Chol）. Insulin resistance was assessed by homeostasis model assessment method （ HOMA - IR）. Results （1） The OSAHS group and OSAHS with MS group had a significantly higher circulating leptin levels than non - OSAHS group （P 〈 O.05,P 〈 0.01）. And leptin levels in OSAHS with MS group also higher than that in OSAHS group （P 〈0. 01）. Severe OSAHS group and moderate OSAHS group had significantly increased leptin levels compared with mild OSAHS group （P 〈 0.05 ,P 〈0.01 ）. （2）In OSAHS group, serum leptin levels correlated positively with AHI, HOMA - IR and BMI, negatively with LSpO2. In OSAHS with MS group serum leptin levels correlated positively with AHI, HOMA - IR, BMI, NC,WHR, SBP, FBG and TG, negatively with LSpO2, multiple stepwise regression analysis identified BMI （ P = 0. 003 ）, HOMA - IR （ P = 0. 024） and AHI （ P = 0. 036 ） as independent correlates. （3）The blood pressure （ in the morning） , especially DBP was significantly higher in OSAHS group than non - OSAHS control group （ P 〈 0.01 ） ; Logistic regression analysis showed that BMI （ P = 0.031 ）, and leptin （ P = 0. 064） were the independent correlates in development of the HT. Conclusions OSAHS compared with simple obesity have higher leptin level, with OSAHS progression, the conexistence of insulin resisitance and hyperleptinemia maybe involved in the pathophysiology of OSAHS combined process of MS.