阻塞性睡眠呼吸暂停低通气综合征患者血清脂联素水平的变化

目的观察阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血清脂联素水平的变化并分析其影响因素。方法选取门诊和住院诊断为OSAHS的患者60例,根据睡眠呼吸暂停低通气指数(AHI)分为轻度、中度、重度三组,每组20例,另选单纯打鼾者20例为对照组。入选者均测量身高、体重、腰围、臀围,计算体重指数(BMI)和腰臀比(WHR);并行一整夜多导睡眠监测(PSG);于PSG检查次日清晨6时抽取空腹静脉血5 mL,检测血清脂联素水平、空腹血糖(FPG)和空腹胰岛素水平(FINS)。结果OSAHS各组血清脂联素水平均明显低于对照组(P<0.05),而FPG和FINS较对照组明显升高(P<0.05),轻、中、重度各组间血清脂联素水平、FPG和FINS差异有显著性(P<0.05);血清脂联素水平与BMI、WHR、AHI、SpO2<90%的时间、FPG及FINS呈显著负相关(相关系数分别为r=-0.66,P<0.01;r=-0.46,P<0.01;r=-0.61,P<0.01;r=-0.36,P<0.01;r=-0.54,P<0.01;r=-0.67,P<0.01),与最低SpO2呈显著正相关(r=0.38,P<0.01),与平均SpO2和年龄无明显相关性;控制BMI、WHR、FPG、FINS后,血清脂联素水平仍与AHI呈显著负相关,与最低SpO2呈显著正相关(相关系数分别为r=-0.38,P<0.01;r=0.23,P<0.05);多元逐步回归分析表明,在OSAHS患者中,AHI是除了FINS和BMI以外的血清脂联素水平的独立影响因子。结论OSAHS患者血清脂联素水平较对照组明显降低,且与OSAHS病情严重程度有明显相关性,AHI是导致血清脂联素水平下降的独立危险因素。

Research on the serum adiponectin levels in patients with obstructive sleep apnea-hypopnea syndrome

Objective To study the changes and the influential factors of serum adiponectin levels in patients with obstructive sleep apneahypopnea syndrome(OSAHS).Methods Overnight polysomnography was performed during sleep and serum adiponectin levels,fasting plasma glucose(FPG),and fasting plasma insulin(FINS) were measured in 60 patients with OSAHS(experimental group) and 20 simple snorers(control group).The OSAHS patients were divided into mild,moderate and severe groups depending on the apnea-hypopnea index(AHI).Results Serum adiponectin levels in each OSAHS group were significantly lower than those in control group(P<0.05) while FBG and FINS in each OSAHS group were significantly higher than those in control group(P<0.05).The levels of adiponectin,FBG,FINS were also significantly different between the mild,moderate and severe OSAHS groups(P<0.05).Serum adiponectin levels were significantly negatively correlated with the body mass index(BMI)(r=-0.66,P<0.01),waist hip ratio(WHR)(r=-0.46,P<0.01),AHI(r=-0.61,P<0.01) and duration of less than 90% of SpO_2(r=-0.36,P<0.01) as well as FPG(r=-0.54,P<0.05) and FINS(r=-0.67,P<0.01),but significantly positively correlated with the minimum value of SpO_2(r=0.38,P<0.01).Partial correlation analysis showed that serum adiponectin levels were still correlated negatively with AHI(r=-0.38,P<0.01) and correlated positively with the minimum value of SpO_2(r=0.23,P<0.05) after adjusted by BMI,WHR,FPG and FINS.Multiple stepwise regression analysis showed that AHI was an independent risk factor for the decrease of serum adiponectin levels beside FINS and BMI.Conclusions In patients with OSAHS,serum adiponectin levels decrease significantly and correlate significantly with the severity of OSAHS.AHI is an independent factor contributing to the decreased levels of serum adiponectin.