男性阻塞性睡眠呼吸暂停低通气综合征对2型糖尿病患者骨代谢及骨密度的影响

目的 探讨男性阻塞性睡眠呼吸暂停低通气综合征（OSAHS）对2型糖尿病（T2DM）患者血糖、骨代谢及骨密度（BMD）的影响。方法 收集2016年5月至2019年4月就诊于甘肃省人民医院的T2DM男性患者，根据多导睡眠监测仪（PSG）中的睡眠呼吸暂停指数（AHI）分为单纯T2DM组（对照组）、T2DM合并轻度OSAHS组（轻度组）、T2DM合并中重度OSAHS组（重度组），测定血清钙（Ca）、磷（P）、维生素D（VitD）、骨钙素（OSTE）和其β 胶原特殊序列（β CTX）的浓度, 同时测定平均血糖水平（MBG）、糖化血红蛋白（HbA1c），应用美国双能X线骨密度仪测定受试者腰椎 (L1 4) 及左侧股骨(LF)骨密度（BMD）。分别比较3组血糖、骨代谢指标、骨密度指标，并分析AHI与上述指标的相关性。 结果 3组P、OSTE、β CTX、及L1 4 BMD差异无统计学意义（P＞0.05）；与对照组比较, 轻、重度组MBG、HbA1c增高，VitD、Ca及LF BMD降低（P＜0.05）；重度组VitD、Ca、MBG、HbA1c与轻度组比较，差异有统计学意义（P＜0.05）。相关性分析表明OSAHS合并T2DM患者AHI与BMI、MBG、β CTX呈正相关（r=0.607, 0.208, 0.169，P=0.000, 0.014, 0.046）；与VitD呈负相关(r=-0.276, P=0.001)。结论 OSAHS可能会进一步加剧T2DM患者糖代谢和骨代谢紊乱，且随着OSAHS的病情进展逐渐加重。

Effect of male obstructive sleep apnea hypopnea syndrome on bone metabolism and bone mineral density in patients with type 2 diabetes mellitus

Objective To explore the effect of male obstructive sleep apnea hypopnea syndrome (OSAHS) on blood glucose, bone metabolism and bone mineral density(BMD) in patients with type 2 diabetes mellitus (T2DM). Methods Male patients with T2DM admitted to Gansu Provincial People's Hospital from May 2016 to April 2019 were collected. The patients were divided into simple diabetes group (control group), T2DM with mild OSAHS group (mild group) and T2DM with moderate severe OSAHS (severe group) according to Apnea Hypoventilation Index（AHI） by polysomnography（PSG） monitor. Calcium (Ca), phosphorus (P), vitamin D (VitD), osteocalcin (OSTE) and beta crosslaps (β CTX) were detected, average blood glucose level (MBG), and glycosylated protein (HbA1c) were tested. The bone mineral density (BMD) of lumbar spine (L1 4) and left femur (LF) were measured by US dual energy X ray absorptiometry. The MBG and indexes of bone metabolism and BMD were compared, and the correlation between AHI and the above indexes were analyzed. Results There were no significant differences in P, OSTE, β CTX, and L1 4 BMD among three groups (P>0.05). Compared with control group, MBG and HbA1c of mild and severe groups increased. While VitD, Ca and LF BMD decreased (P<0.05). The difference in VitD, Ca, MBG and HbA1c between severe group and mild group were statistically significant (P<0.05). AHI was positively correlated with BMI, MBG, and β CTX in patients with OSAHS and T2DM (r=0.607, 0.208, 0.169; P=0.000, 0.014, 0.046); it was negatively correlated with VitD (r=-0.276, P=0.001). Conclusion OSAHS may further aggravate glucose metabolism and bone metabolism disorder inT2DM patients, and it will gradually increase with the progress of OSAHS.