摘要目的 探讨合并阻塞性睡眠呼吸暂停综合征(OSAS)的2型糖尿病患者的炎性因子变化情况,并探讨其与睡眠中低氧血症发病的相关性.方法 收集2008年12月至2009年12月大连医科大学附属第二医院住院的2型糖尿病患者54例,其中男29例,女25例,平均年龄(61±10)岁,根据是否合并OSAS分为OSAS组和非OSAS组,同期纳入26名健康体检者作为对照组.所有患者进行血清肿瘤坏死因子-α(TNF-α)、脂多糖、单核细胞趋化蛋白(MCP)及凝血酶原激活物抑制物(PAI)检测,采用酶联免疫法进行血清生物化学检查,多导睡眠初筛仪测试夜间最低脉搏血氧饱和度(LSpO2)及呼吸暂停低通气指数(AHI).结果 OSAS组的稳态胰岛素抵抗指数(HOMA-IR)为2.7±1.5,AHI为(17.0±13.O)次/h;非OSAS组HOMA-IR为1.7±0.9,AHI为(3.4±1.3)次/h;对照组HOMA-IR为1.2±0.7,AHI为(3.2±1.2)次/h.OSAS组夜间LSpO2[(78±11)％]低于非OSAS组[(87±4)％]和对照组[(89±6)％];与对照组相比,OSAS组和非OSAS组的TNF-α、脂多糖、MCP和PAI均明显升高.单因素Pearson相关分析结果显示,TNF-α和PAI均与HOMA-IR、空腹血糖和AHI呈正相关,与夜间LSpO2呈负相关;脂多糖、MCP与空腹血糖、AHI呈正相关,与夜间LSpO2呈负相关.多元线性逐步回归分析显示影响TNF-α及脂多糖的因素为AHI和空腹血糖,影响MCP的因素为夜间LSpO2,影响PAI的因素为AHI和HOMA-IR.结论 合并OSAS的2型糖尿病患者的慢性炎性因子分泌升高,炎症状态更重.

abstractsObjective To investigate whether the existence of obstructive sleep apnea syndrome (OSAS) in patients with type 2 diabetes (T2DM) is associated with low grade chronic inflammation.Methods Fifty-four patients hospitalized for poor glycemic control from 12/2008 to 12/2009 were divided into 2 groups,OSAS group (T2DM with OSAS,27 cases) and NOSAS group (T2DM without OSAS,27 cases).The control group consisted of 26 people from a health check-up program without diabetes and OSAS.Biochemical indexes were analyzed in central laboratory of the hospital.Serum tumor necrosis factorα(TNF-α),lipopolysaccharides (LPS),monocyte chemoattractant protein-1 (MCP),and plasminogen activator inhibitor-1 (PAI) levels were determined with commercial ELISA kits.Apnea hypopnea index (AHI),the lowest pulse oxygen saturation(LSpO2) at night were measured with a portable home sleep monitor.Results Homeostasis model assessment insulin resistance index (HOMA-IR),AHI in OSAS group were higher than those in NOSAS group and control group [for HOMA-IR,2.7 ± 1.5 vs 1.7 ± 0.9 vs 1.2 ± 0.7,and for AHI,(17.0 ±13.0) vs (3.4±1.3) vs (3.2 ±1.2) perhour],and LSpO2 was lower than that in NOSAS group and control group [(78 ± 11) ％ vs (87 ± 4) ％ vs (89 ± 6) ％].Compared with normal control,levels of TNF-α[(0.73 ±0.19) vs (1.97 ±0.13) vs (1.09 ±0.29) ng/ml],LPS[(50 ± 11) vs (303 ±70) vs (171 ±49)pg/ml],MCP [(302 ±41) vs (514 ±122) vs (473 ±134) pg/ml] and PAI [(0.89 ±0.25) vs (2.27 ±0.85) vs (1.59 ±0.13) ng/ml] in patients with OSAS and with NOSAS group increased significantly.Pearson univariate correlation analysis revealed that TNF-α and PAI were both positively associated with HOMA-IR,FBG and AHI,and negatively with LSpO2,LPS,MCP were both associated positively with FBG and AHI,and negatively with LSpO2.Multiple linear regression stepwise analysis found that TNF-α and LPS were independently associated with AHI and FBG,MCP with LSpO2,PAI with both AHI and HOMA-IR.Conclusions Patients with diabetes and OSAS show raised level of chronic inflammatory activity.