阻塞性睡眠呼吸暂停对非酒精性脂肪性肝病影响的研究进展

摘要

阻塞性睡眠呼吸暂停(OSA)可能与非酒精性脂肪性肝病(NAFLD)的发生、发展密切相关.OSA可引起NAFLD患者转氨酶升高、肝细胞炎症、肝纤维化,甚至参与NAFLD的进展,其机制可能与夜间间歇性低氧(CIH)、肝细胞凋亡和巨噬细胞浸润、肠肝轴失调相关.其中CIH可能是最重要的机制,CIH可诱导炎症反应,加重胰岛素抵抗与脂代谢异常,参与氧化应激、脂质过氧化、线粒体功能失调,并可以增加赖氨酰氧化酶加重肝纤维化.肥胖患者通过CIH更易诱导出NAFLD.持续气道正压通气对OSA合并NAFLD的治疗疗效仍存在争议.OSA对NAFLD的影响值得引起重视,可能为治疗NAFLD提供新思路.%Obstructive sleep apnea ( OSA) may be closely related to the onset and development of non-alcoholic fatty liver disease(NAFLD).OSA causes elevation of transaminase ,inflammation,even fibrosis in patients with NAFLD.OSA also participates in the development of NAFLD .The mechanism may be the chronic intermittent hypoxia ( CIH) ,the apopto-sis of liver cells ,the infiltration of macrophages and the disorder of the gut-liver axis .CIH may be the most important mecha-nism.Firstly,CIH can induce inflammatory reaction ,aggravate insulin resistance and dyslipidemia ,participate in oxidative stress,lipid peroxidation and mitochondrial dysfunction , and increase lysine oxidase which may aggravate liver fibrosis . Obese patients are more likely to develop NAFLD induced by CIH .The efficacy of continuous positive airway pressure in the treatment of OSA combined with NAFLD remains controversial .The relationship between OSA and NAFLD is worth our at-tention,and it may provide a new idea for the treatment of NAFLD .