慢性间歇低氧对阻塞性睡眠呼吸暂停低通气综合征患者胰岛素功能的影响

目的 探讨慢性间歇低氧及继发的氧化应激对OSAHS患者胰岛素抵抗(IR)、胰腺β细胞功能的影响.方法 研究纳入15例单纯性鼾症患者、31例轻中度OSAHS患者及34例重度OSAHS患者.其中单纯性鼾症患者15例,男14例,女1例;轻中度OSAHS患者31例,男29例,女2例;重度OSAHS患者34人,男31例,女3例.所有患者收集一般临床资料,采用多导睡眠仪整晚监测取得夜间睡眠资料.用ELISA法检测8异前列腺素(8-isoprostane)、空腹血胰岛素(FINS),分光光度计法检测谷胱甘肽过氧化物酶(GSH-Px).采用稳态模型胰岛素抵抗指数(HOMA-IR)、FINS评价IR,稳态模型胰腺β细胞功能指数(HOMA-β)评价胰腺β细胞功能.三组数据间的比较采用多个独立样本非参数检验(Kruskal-Wallis H 检验),两两比较采用Nemenyi检验.数据间的相关性采用spearman秩相关分析,采用多元线性回归分析排除数据间的干扰.计数资料采用χ2检验.结果 随着OSAHS病情的加重,3组患者血清8-异前列腺素、GSH-Px、空腹血糖(FBG)、FINS及HOMA-IR整体比较均存在统计学差异(P=0.0034,P<0.0001).3组患者HOMA-β未发现明显差异(P>0.05).血清氧减指数(ODI)、血氧饱和度<90%时间占总睡眠时间的百分比(CT90%)、最低氧合血红蛋白饱和度(SaO2)、平均SaO2均与FINS、HOMA-IR存在相关性,相关系数从ODI到平均SaO2逐渐减小.用多元线性回归分析校正年龄、体重指数(BMI)的影响后,ODI、CT90%及最低SaO2依然和FINS、HOMA-IR存在相关性,标准化回归系数R从ODI、CT90%到最低SaO2逐渐减小.OSAHS患者血清8-异前列腺素、GSH-Px与FINS、HOMA-IR均存在相关性(P<0.05).用多元线性回归分析校正年龄、BMI的影响后,8-异前列腺素仍然和FINS、HOMA-IR存在相关性.HOMA-β与AHI、BMI、ODI、CT90%、最低SaO2、平均SaO2、8-异前列腺素、GSH-Px均不存在相关性(P>0.05).结论 OSAHS特征性的慢性间歇低氧与IR独立相关,与低氧严重程度相比,IR与氧减次数的联系更密切.OSAHS增强的氧化应激与IR独立相关,未发现胰腺β细胞功能和慢性间歇低氧及继发的氧化应激之间存在相关性.

The influence of chronic intermittent hypoxia on insulin function in OSAHS patients

Objective To discuss the influence of chronic intermittent hypoxia and secondum oxidative stress on insulin resistance and the function of Pancreatic β cells in OSAHS patients. Methods 15 patients with primary snoring, 31 patients with light to moderate OSAHS and 34 patients with severe OSAHS were investigated. General clinical data of every patient were collected, while nocturnal data were gained by using PSG with entire night monitor. 8-isoprostane and fasting insulin (FINS) were detected through ELISA; GSH-Px through Spectrophotometer. Insulin resistance was evaluated by measuring HOMAIR and FINS, while the function of Pancreatic β cells by HOMA-β. The comparison among the three groups were used by the non-parametric Kruskal-Wallis H test, and Nemenyi test was used for pairwise comparison.The relativity between the variables were assessed by Spearman correlation test, and multiple linear regression was used to remove interference between variables. The enumeration data were compared with χ2 test. Results 1. Along with the aggravation of OSAHS, the three groups were statistically different from each other on 8-isoprostane, GSH-Px, fasting blood glucose (FBG), FINS, and HOMA-IR (P= 0.0034,P<0.0001), but not on HOMA-β (P >0.05). 2. ODI, CT90%, lowest SaO2 and mean SaO2 were correlated with FINS and HOMA-IR in the serum, while the coefficient of correlation r decreased from ODI to mean SaO2. After ruling out the influence of age, BMI by multiple linear regression, ODI, CT90% and lowest SaO2 still correlated with FINS and HOMA-IR, the standardized regression coefficient R diminished from ODI, CT90% to lowest SaO2. 3. 8-isoprostane and GSH-Px correlated with FINS and HOMA-IR in OSAHS patients (P<0.05). After eliminated the influence of age, BMI by multiple linear regression, 8-isoprostane still correlated with FINS and HOMA-IR. 4. HOMA-β has no correlation with AHI, BMI, ODI,CT90%, lowest SaO2, mean SaO2, 8-isoprostane and GSH-Px(P > 0.05). Conclusion 1.Chronic intermittent hypoxia of OSAHS was independently correlated with IR. Compared with the severity of hypoxia,the insulin resistance has a closer relation with oxygen desaturation index. 2. Secondum oxidative stress in OSAHS was independently correlated with IR. 3. We didnt find the function of Pancreatic β cells correlating with chronic intermittent hypoxia and secondum oxidative stress.