阻塞性睡眠呼吸暂停综合征对肝脏酶谱影响的配对研究

摘要

目的:评价阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS) 对肝脏酶学的影响.方法:选择30 例按照体重指数配对的不同程度OSAS 男性患者,进行睡眠呼吸暂停监测,并于清晨空腹抽血测定空腹血糖,空腹胰岛素水平,血清丙氨酸氨基转移酶、天门冬氨酸氨基转氨酶及乳酸脱氢酶水平.结果:按照体重指数配对的AHI<15/h 与AHI>15/h 的两组患者体重指数、年龄、腰臀比、颈围均无统计学差异.两组患者AHI 水平有统计学差异(6.67±5.16/h vs 31.69±22.91/h,p= 0.001);夜间最低血氧饱和度有统计学差异(88.07±6.69 % vs 79.47±11.31%,p=0.019).AHI>15/h 组患者胰岛素抵抗指数较AHI<15/h 组患者升高并有统计学差异(1.47±0.58 vs 0.94±0.49,p=0.001).AHI>15/h 组患者空腹血清丙氨酸氨基转移酶水平较AHI<15/h 组患者升高并有统计学差异(33.82±33.37 IU/L vs 20.06±13.64 IU/L,p=0.040);乳酸脱氢酶水平升高并有统计学差异(165.83±37.50 IU/L vs 144.93±21.28 IU/L,p=0.047).结论:随着OSAS 严重程度增加,胰岛素抵抗程度增加,血清丙氨酸氨基转移酶及乳酸脱氢酶升高;提示OSAS 可能通过间断缺氧途径及胰岛素抵抗途径导致肝功能损伤,引起非酒精性肝病.%Objective:Analysis on the levels of serum liver enzymes in patients with obstructive sleep apnea syndrome patientspaired on BMI. Methods: Thirty male patients with OSAS, matched with body mass index (BMI) were selected. The levels of serum insulin, alanine transaminase (ALT), aspartate transaminase (AST), and lactate dehydrogenase (LDH) were measured and analyzed. Results:Comparedwith control group, the AHI>15/h group observes a significantly higher AHI (31.69 ± 22.91/hvs 6.67 ±5.16/h, p= 0.001), lower Lowest SpO2%(79.47 ± 11.31 vs 88.07 ± 6.69, p=0.019), higher insulin resistance index(l .47 ± 0.58 vs 0.94 ± 0.49, p=0.001), higher level of ALT (33.82 + 33.37 IU/L vs 20.06 + 13.64 IU/L,p=0.040) and higher level of LDH(165.83+37.50 IU/L vs 144.93+21.28 IU/L, p=0.047). BMI, age, waist to hip ratio, and neck circumstance were similar in both groups. Conclusion:With increasing severity of OSAS, increased insulin resistance and elevated levels of ALT and LDH were observerd; which indicate that OSAS may cause liver damage andnon-alcoholic liver disease through the pathway of intermittent hypoxia and insulin resistance .