持续气道正压通气对合并阻塞性睡眠呼吸暂停低通气综合征的2型糖尿病患者糖代谢及糖皮质激素的影响

目的 探讨持续气道正压通气(CPAP)对合并有阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的2型糖尿病(T2DM)患者糖代谢及糖皮质激素的影响.方法 选取2008年7月至2009年12月于卫生部北京医院内分泌科确诊合并有OSAHS的T2DM患者36例.对无禁忌者应用至少30 d的CPAP治疗.在治疗前后检测受试患者血糖、胰岛素敏感性指标及糖皮质激素水平.采用配对t检验对受试者前后指标进行分析.结果 应用CPAP治疗后受试者空腹血糖(6.5±1.1)mmol/L]及糖化血红蛋白水平(7.1%±1.0%)较治疗前(10.0±3.0)mmol/L,(9.1±2.2)%]显著降低(t=6.517,P<0.001;t=7.239,P<0.001),治疗后胰岛素抵抗(IR)的稳态模式评估指数(HOMA-IR)显著降低(3.4±1.9和2.6±2.0;t=2.204,P<0.05),促肾上腺皮质激素(ACTH)及皮质醇(COR)水平没有显著变化(P>0.05).结论 CPAP可以全面改善合并有OSAHS的2型糖尿病患者的血糖控制及胰岛素抵抗,是除生活方式干预及药物治疗外的一种行之有效的治疗手段.

Effect of continuous positive airway pressure therapy on glucose metabolism and glucocorticoid in patients with obstructive sleep apnea-hypopnea syndrome and type 2 diabetes

Objective To investigate the effects of continuous positive airway pressure (CPAP) treatment on glucose metabolism and glucocorticoid in patients with obstructive sleep apnea-hypopnea syndrome(OSAHS) and type 2 diabetes mellitus(T2DM). Methods To use at least 30 days of CPAP treatment on 36 cases of patients with T2DM and newly diagnosed OSAHS hospitalized during July 2008 and December 2009 in the Department of Endocrinology, Beijing Hospital. To take CPAP treatment for the patients without contraindication. Insulin sensitivity and glucose metabolism were tested and compared to the data previously obtained. Paired-t-test were used for statistical analysis. Results After the application of CPAP treatment,the glycohemoglobin ( (7.1±1.0)% ) and fasting blood glucose( (6.5 ± 1.1 ) mmol/L)were lower than that been previous obtained ( HbA1c (9.1 ± 2. 2) %, FBG ( 10.0±3.0) mmol/L; t = 6.517,P < 0. 001 ;t = 7. 239, P < 0. 001 ), and the homeostasis model assessment (HOMA) index of insulin resistance was significantly lower compared with that obtained before the CPAP treatment ( 3.4 ± 1.9 vs2. 6 ± 2.0; t = 2. 204, P < 0.05 ), but there were no significant changes of ACTH and COR ( P > 0.05 ).Conclusion CPAP can cause an overall improvement in insulin sensitivity in type 2 diabetes patients with OSAHS, CPAP is also an effective treatment in addition to lifestyle intervention and drug treatment.