阻塞性睡眠呼吸暂停低通气综合征相关肝损害的危险因素研究

目的 探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者肝酶升高及非酒精性脂肪性肝病(NAFLD)的危险因素。方法 选取首都医科大学附属北京顺义区医院2017年7月—2019年7月收治的OSAHS患者162例,根据肝酶是否升高分为肝酶升高组(68例)和肝酶正常组(94例),根据是否合并NAFLD分为NAFLD组(56例)和非NAFLD组(106例),分析影响OSAHS肝损伤的危险因素。结果 肝酶升高组睡眠呼吸暂停低通气指数(AHI)、减氧指数(ODI)、血氧饱和度低于90%的时间(CT90)、体质量指数(BMI)、爱泼沃斯嗜睡量表(Epworth sleepiness score, ESS)评分、谷丙转氨酶(ALT)、谷氨酰转肽酶、总呼吸暂停时间高于肝酶正常组(均P<0.05),最低血氧饱和度(LSaO₂)低于肝酶正常组(P<0.001);NAFLD组AHI、ODI、CT90、BMI、ESS评分、ALT、AST、GGT、TG、总呼吸暂停时间均高于非NAFLD组(均P<0.05),LSaO₂低于非NAFLD组(P<0.001);ODI、LSaO₂为肝酶升高的独立危险因素(OR_ODI=1.184,OR_LSaO2=1.091;均P<0.001);BMI、ODI、CT90是OSAHS合并NAFLD独立危险因素(OR_BMI=1.395,OR_ODI=1.274,OR_CT90=1.295;均P<0.001)。结论 ODI、LSaO₂是OSAHS患者肝酶升高的独立危险因素,BMI、ODI、CT90是OSAHS合并NAFLD发病的独立危险因素。 

Risk factors of liver damage associated with obstructive sleep apnea hypopnea syndrome

Objective To investigate the risk factors of elevated liver enzymes and nonalcoholic fatty liver disease(NAFLD) in patients with obstructive sleep apnea hypopnea syndrome(OSAHS). Methods A total of 162 OSAHS patients admitted to Beijing Shunyi District Hospital affiliated to Capital Medical University from July 2017 to July 2019 were selected and divided into a group of 68 patients with elevated liver enzymes and a group of 94 patients with normal liver enzymes. Patients with or without NAFLD were divided into a NAFLD group of 56 patients and a non-NAFLD group of 106 patients. The risk factors affecting OSAHS liver injury were analyze. Results In the elevated liver enzymes group, the AHI, ODI, CT90, BMI, ESS score, ALT, GGT total apnea time were significantly higher than those in the normal liver enzymes group(all P<0.05), and the LSaO₂ was significantly lower than that in the normal liver enzymes group(P<0.01). The sleep apnea hypopnea index(AHI), oxygen loss index(ODI), duration of blood oxygen saturation below 90%(CT90), body mass index(BMI), ESS score, and total apnea duration in the NAFLD group were significantly higher than those in the non-NAFLD group(all P<0.05), and the minimum oxygen saturation(LSaO₂) was significantly lower than that in the non-NAFLD group(P<0.01). The ODI and LSaO₂ were independent risk factors for liver enzyme elevation(OR_ODI=1.184; OR_LSaO2=1.091; all P<0.001). The BMI, ODI and CT90 were independent risk factors for OSAHS associated NAFLD(OR_BMI=1.395; OR_ODI=1.274; OR_CT90=1.295; all P<0.001). Conclusion The ODI and LSaO₂ are independent risk factors for liver enzyme elevation in OSAHS patients, while the BMI, ODI and CT90 are independent risk factors for OSAHS patients with NAFLD.