阻塞性睡眠呼吸暂停综合征对2型糖尿病患者血脂异常及颈动脉粥样硬化的影响

摘要

Objective To study the influence of obstructive sleep apnea syndrome(OSAS on dyslipidemia and carotid atherosclerosis in patients with type 2 diabetes mellitus.Methods Eligible inpatients with type 2 diabetes in PLA Hospital307 were selected,who were monitored by ResMedApneaLinkTM Plus portable sleep testing devices.These patients were classified into the mild,moderate and severe OSAS groups according to the apnea-hypopnea index (AHI).All these patients underwent carotid artery ultrasound scan,and their disease course information and baseline parameters including age,waist circumference,body mass index(BMI) and mean artery pressure (MAP) were recorded.Their blood samples were also collected for laboratory tests of hemoglobin A1c (HbA1c),fasting blood glucose (FBG),2-hour postprandial blood glucose,total cholesterol (TC),triglyceride (TG),high-density lipoproteincholesterol(HDL-C) and low-density lipoprotein-cholesterol(LDL-C).Results There were 106 patients who completed all the tests,71 of whom were combined with OSAS(67％),with 36,19 and 16 patients in the mild,moderate and severe OSAS groups respectively.OSAS patients had higher levels of TC [(5.16 ± 1.04) mmol/L vs (4.68 ± 1.13) mmol/L,P ＜ 0.05],TG [(2.57 ± 1.27) mmol/L vs (1.81 ±0.78) mmol/L],P ＜ 0.05) and LDL-C[(2.78 ±0.76) mmol/L vs (2.34 ±0.82) mmol/L],P ＜0.05),but lower levels of HDL-C [(1.21 ± 0.45) mmol/L vs (1.43 ± 0.34) mmol/L],P ＜ 0.05) than non-OSAS patients.There were far more cases of carotid atherosclerosis in OSAS group than in non-OSAS group (62.0％ vs 31.4％,P ＜ 0.05).Multivariate logistic regression analysis revealed that LDL-C levels (OR1.19,95 ％ CI 1.07-1.21,P ＜ 0.05) and apnea-hypopnea index (AHI) (OR 1.13,95 ％ CI 0.89-1.14,P ＜ 0.05) were independently related to the incidence of carotid atherosclerosis.Conclusions Patients with type 2 diabetes mellitus combined with OSAS are susceptible to more severe dyslipidemia,and high levels of LDL-C and OSAS severity are independently related to the incidence of carotid atherosclerosis.%目的 研究阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)对2型糖尿病患者血脂异常及颈动脉粥样硬化的影响.方法 收集符合人组条件的2型糖尿病患者进行睡眠呼吸监测,根据每小时睡眠呼吸暂停次数(ap-nea-hypopnea index,AHI)诊断OSAS并判断病情轻重,行超声检查诊断颈动脉粥样硬化.同时记录病程、年龄、腰围,体重指数等临床基本资料,测量血压并计算平均动脉压(mean artery pressure,MAP),完善糖化血红蛋白(HbA1c)、空腹及餐后2h血糖、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL-C)及低密度脂蛋白(LDL-C)检验.结果 106例入组患者中,71例合并OSAS患者为患病组(67％),其中重度16例,中度19例,轻度36例.35例未合并OSAS患者为对照组.患病组TC [(5.16±1.04) mmol/L vs(4.68±1.13) mmol/L,P ＜0.05]、TG[(2.57±1.27) mmol/L vs(1.81±0.78) mmol/L],P＜0.05)、LDL-C[(2.78±0.76) mmol/Lvs(2.34±0.82) mmol/L],P＜0.05)均高于对照组;患病组HDL-C[(1.21±0.45) mmol/L vs(1.43±0.34) mmol/L],P＜0.05)低于对照组.患病组中颈动脉粥样硬化患者更为多见(62.0％vs31.4％,P＜0.05).进行多因素logistics回归分析后,可见LDL-C(OR1.19,95％CI 1.07～1.21,P＜0.05)、AHI(OR1.13,95％ CI 0.89～1.14,P＜0.05)与颈动脉粥样硬化独立相关.结论 合并OSAS的患者血脂代谢异常更为严重,LDL-C和OSAS严重程度与颈动脉粥样硬化患病独立相关.