阻塞性睡眠呼吸暂停低通气综合征对非肥胖老年人非酒精性脂肪性肝病的影响

摘要

Objective To investigate the impact of obstructive sleep apnea hypopnea syndrome (OSAHS) on development of nonalcoholic fatty liver disease (NAFLD) in the non-obese elderly.Methods A total of 91 non-obese elderly patients were divided into 3 groups,29 cases with mild to moderate SAHS (mild-to-moderate OSAHS group),31 cases with severe OSAHS (severe OSAHS group),30 cases without OSAHS and matched with age,sex and BMI (control group).The changes in NAFLD severity index including serum liver enzyme levels,Type Ⅲ procollagen peptide (PⅢ P)and liver/spleen CT ratio were observed,and the influence factors for the changes were analyzed.Results Serum alanine aminotransferase (ALT),aspartate aminotransferase (AST)ALT/AST ratio and serum PⅢ P levels were significantly higher in severe OSAHS group than in mild-to-moderate OSAHS and the control group(F=25.71,15.15,18.64,respectively,all P＜0.01).There was no significant differences in serum liver enzyme ALT,AST and P Ⅲ P levels between mild-to-moderate OSAHS and the control groups(all P＞0.05),and the ALT/AST ratio was significantly higher in mild-to-moderate OSAHS group than in the control group(P＜0.01).The Liver/spleen CT ratio was significantly lower in OSAHS groups than in control group,while the ratio was lower in severe OSAHS group than in mild-to-moderate OSAHS group(all P＜0.01 or 0.001).Serum PⅢ P level was significantly higher in OSAHS groups than in control group(F=31.46,P＜0.01),while PlⅢ P levels were not significantly different between the mild-to-moderate OSAHS group and the control group(P ＞ 0.05).The correlation analysis showed that the liver/spleen CT ratio in OSAHS group was negatively correlated with AHI(r=-0.785,P＜0.001),but was positively correlated with the lowest oxygen saturation(r=0.517,P=0.001).The ALT/AST ratio and serum P Ⅲ P level in OSAHS patients were positively correlated with AHI (r=0.463,0.770,both P＜0.001),but were negatively correlated with the lowest oxygen saturation (r=-0.395,-0.514,P＜0.01 or 0.001).The multiple regression analysis showed that AHI was the only variable that affected liver/spleen CT ratio and serum P Ⅲ P level in OSAHS patients.Conclusions OSAHS patients in the non-obese elderly are always complicated with NAFLD,characterized by abnormal liver enzymes,hepatic steatosis and fibrosis.The severity of lesion is increased with the deterioration of OSAHS.AHI may play an important role in the development of NAFLD in the non-obese elderly with OSAHS.%目的 探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)对非肥胖老年人非酒精性脂肪性肝病(NAFLD)发生的影响. 方法 选择经多导睡眠图检测确诊的非肥胖老年轻度至中度OSAHS患者(轻中度OSAHS组)29例、重度OSAHS患者(重度OSAHS组)31例及年龄、性别、体质指数相匹配的非OSAHS者(对照组)31例为研究对象,以血清肝酶水平、血清Ⅲ型前胶原肽(PⅢP)水平及肝/脾CT比值作为评估NAFLD严重程度的指标,比较3组患者各指标变化并分析其影响因素. 结果 重度OSAHS组血清肝酶丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)、ALT/AST比值水平明显高于轻中度OSAHS组和对照组(F=25.71、15.15、18.64,均P=0.000),轻中度OSAHS组与对照组比较,血清肝酶ALT、AST水平差异无统计学意义(均P＞0.05),ALT/AST比值明显高于对照组(P＜0.01);肝/脾CT比值比较,重度OSAHS组、轻中度OSAHS组明显低于对照组(F=103.43,P=0.000),重度OSAHS组明显低于轻中度OSAHS组(P=0.000);重度OSAHS组血清PⅢP水平明显高于轻中度OSAHS组和对照组(F=31.46,P=0.000),轻中度OSAHS组与对照组比较血清PⅢP水平差异无统计学意义(P＞0.05).相关分析结果显示,OSAHS患者肝/脾CT比值与AHI呈负相关(r=-0.785,P=0.000),与最低血氧饱和度呈正相关(r=0.517,P=0.001);OSAHS患者的血ALT/AST比值、血PⅢP水平与呼吸暂停低通气指数(AHI)呈正相关(r=0.463、0.770,均P=0.000),与最低血氧饱和度呈负相关(r=-0.395、-0.514,P=0.002、0.000).多元回归分析显示,AHI是影响OSAHS患者肝/脾CT比值和血清PⅢP值的唯一变量. 结论 非肥胖老年OSAHS患者存在NAFLD相关性肝损伤,表现为肝酶异常、肝脏脂肪变性及肝纤维化倾向,且随着OSAHS严重程度增加而加重;AHI是非肥胖老年OSAHS患者NAFLD的重要危险因素.