阻塞性睡眠呼吸暂停低通气综合征与胰岛素抵抗的关系的临床研究

目的：探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）与胰岛素抵抗的关系及改良悬雍垂腭咽成形术（MUPPP）和持续正压通气（CPAP）治疗OSAHS对胰岛素抵抗的影响。方法：经PSG确诊为OSAHS患者42例，32例行MUPPP手术及CPAP治疗（治疗组），10例患者未治疗（未治疗组），另选择33例不符合OSAHS诊断者为对照组。分别测定MUPPP及CPAP治疗前和治疗后30d空腹血糖及胰岛素，餐后2h血糖及胰岛素水平，分析AHI、最低血氧饱和度（LSaO2）与空腹血糖、胰岛素及餐后血糖、胰岛素的关系。计算胰岛素抵抗指数（IR）和胰岛素敏感指数（IAI），对AHI、LSaO2、IR、IAI进行多因素相关分析。结果：治疗组治疗前各临床参数指标与对照组比较，治疗前、后比较及治疗后与未治疗组比较，均差异有统计学意义（P〈0．01或P〈0．05）。IR与AHI明显正相关（r=0．690），与LSaO2明显负相关（r=0．686），IAI与AHI明显负相关（r=0．654），与LSaO2明显正相关（r=0．633），均P〈0．01。结论：OSAHS与IR之间存在独立相关关系；OSAHS低氧可引起胰岛素抵抗，通过MUPPP及CPAP治疗可以提高胰岛素的敏感性，降低IR。

The clinical investigation of the relationship between obstructive sleep apnea-hypopnea syndrome and insulin resistance

Objective:To study the relationship between obstructive sleep apnea-hypopnea sydrome(OSAHS)and insulin resistance(IR),then evaluate the effectiveness of the improved Uvulopalatopharyngoplasty(MUPPP)and continuous positive airway pressure(CPAP)on IR.Method:Fourteen patients of OSAHS were treated by MUPPP,and sixteen patients of OSAHS were treated by CPAP.All index of the noctural polysomnography,fasting plasma insulin,fasting plasma glucose,insulin and blood suger of 2 hours after meal were analyzed before and after therapy,and 10 patients of OSAHS were untreated by MUPPP or CPAP.The other 33 cases of non-OSAHS were selected as control group.According to the model of HOMA and the formula of LiGuangwei,insulin resistance index and insulin sensitivity index were calculated,respectively.Result:There were significant differences between OSAHS group before treatment and control group,before and after treatment,after treatment and untreated group(P<0.01 or P<0.05).There was very significant correlation between IAI and LSaO2(r=0.633),and there was significantly negative correlation between IAI and AHI(r=-0.654).Conclusion:OSAHS is an important risk factor for the development of insulin resistance.It shows that OSAHS may develop IR of the patients and the treatment of MUPPP and CPAP can improve insulin sensitivity.