目的 探索2型糖尿病合并阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患者超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)水平的变化及各临床指标与颈动脉内膜中层厚度(intima-media thickness,IMT)的相关性,为心脑血管病的早期诊断及预防提供参考.方法 纳入自2014年4月至2016年10月在山东大学齐鲁医院青岛院区住院的2型糖尿病患者327例.根据多导睡眠图(polysomnography,PSG)呼吸暂停低通气指数(apnea-hypopnea index,AHI)分为对照组(AHI<5,n=133)及OSAHS组(AHI≥5,n=219),并将OSAHS组分为3个亚组:即轻度OSAHS组(5≤AHI<15,n=41)、中度OSAHS组(15≤AHI<30,n=108)和重度OSAHS组(AHI≥30,n=45).所有患者超声测量双侧IMT,免疫比浊法测定血清hs-CRP水平.分析2型糖尿病合并OSAHS患者的临床指标与IMT的相关性.结果 2型糖尿病合并中度及重度OSAHS组的体重指数(body mass index,BMI)明显高于对照组及轻度组(P<0.05);对照组与轻度OSAHS组的BMI差异无显著性(P>0.05);中度与重度OSAHS组的BMI差异无显著性(P>0.05).2型糖尿病合并OSAHS组的hs-CRP和颈动脉IMT均高于对照组(P<0.05).进一步分析发现,重度OSAHS组的hs-CRP、颈动脉IMT均高于轻度及中度OSAHS组(P<0.05),中度OSAHS组的hs-CRP高于轻度OSAHS组(P<0.05),而轻、中度OSAHS组的IMT差异无显著性(P>0.05).Pearson相关分析显示,OSAHS患者的左、右颈动脉 IMT与年龄、BMI、hs-CRP、AHI呈显著正相关(P<0.05),与夜间最低血氧饱和度呈显著负相关(P<0.05).多元线性逐步回归分析显示,OSAHS患者的BMI、hs-CRP、AHI及夜间最低血氧饱和度与左、右颈动脉IMT独立相关.结论 2型糖尿病合并中、重度OSAHS患者的BMI明显增高,随OSAHS严重程度增加,炎症指标hs-CRP逐渐升高,颈动脉IMT亦明显增厚.hs-CRP、AHI、夜间最低血氧饱和度、BMI是颈动脉粥样硬化的独立影响因素.%Objective Obstructive sleep apnea hypopnea syndrome (OSAHS) is closely correlated with atherosclerosis and cardiovascular and cerebrovascular diseases. The purpose of this study was to explore the correlation between different severity of OSAHS patients with type 2 diabetes mellitusthe and inflammation index hs-CRP and carotid artery intima-media thickness (IMT),and to provide reference for the early diagnosis and prevention of cardiovascular and cerebrovascular diseases. Method This study included 327 type 2 diabetic patients hospitalized in Qingdao Hospital of Qilu Hospital of Shandong University from April 2014 to October 2016. According to polysomnography (PSG) results, the patients were divided control group (AHI <5, n=133) and OSAHS group (AHI≥5, n=219), and the OSAHS group was divided into three subgroups:mild OSAHS group (5≤AHI <15) (n=41) , moderate OSAHS group (15≤AHI<30) (n=108)and severe OSAHS group (AHI≥30) (n=45). IMT were measured in all patients. The hs-CRP was measured by latex enhanced projection immunoassay. Result The BMI in type 2 diabetes mellitus patients with moderate and severe OSAHS was significantly higher than that the control and mild OSAHS groups (P<0.05), while there was no significant differences in BMI between control and mild OSAHS groups (P>0.05) and There was no significant differences in BMI between moderate and severe OSAHS group (P>0.05).Hs-CRP was significantly higher in OSAHS groups than in the control group(P<0.05). Carotid IMT was significantly higher in OSAHS groups than in the control group(P<0.05). In addition, hs-CRP and carotid IMT were significantly higher in severe OSAHS groups than in the mild and moderate groups(P<0.05). hs-CRP was significantly higher in moderate OSAHS group than in the mild group(P<0.05). However, there were no significant differences in Carotid IMT between mild and moderate OSAHS groups(P>0.05).Pearson correlation analysis showed that carotid IMT of left and right of OSAHS patients was significantly and positively correlated with age, BMI, hsCRP and AHI (P<0.05), and negatively correlated with nighttime lowest oxygen saturation (LSaO2) (P<0.05).Multiple linear stepwise regression analysis showed that BMI, hs-CRP, AHI and lowest oxygen saturation in night were independently associated with left and right carotid IMT in OSAHS patients. Conclusion Patients with type 2 diabetes mellitus and severe OSAHS had significantly higher BMI. With the increase of severity of OSAHS, the index of inflammation hs-CRP increased more obviously, and the carotid IMT thickened more obviously. AHI, lowest oxygen saturation in night, hs-CRP and BMI are independent risk factors for atherosclerosis.
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