青少年肥胖患者阻塞性睡眠呼吸暂停低通气综合征严重情况与血糖及胰岛素抵抗的相关性研究

摘要

目的 通过对青少年肥胖合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者基本情况的对比,研究血糖、胰岛素抵抗与OSAHS严重程度的关系.方法 本科门诊诊断为肥胖的青少年OSAHS患者共250例.所有患者均接受多导睡眠监测,以呼吸暂停低通气指数(AHI)评估OSAHS严重程度.均行75 g口服葡萄糖耐量试验(OGTT)评估机体糖耐量状况;以稳态模型计算胰岛素抵抗指数(HOMA-IR),并运用Bergman微小模型技术结合静脉葡萄糖耐量试验(FSIVGTT)评估胰岛素敏感指数(SI).结果 根据AHI将患者分为无OSAHS、轻度OSHAS、中度OSAHS和重度OSAHS 4组,随着OSAHS严重程度的增加,患者的体质量指数、腰围、颈围、腰臀比、血糖、血脂、糖化血红蛋白(HbA1C)升高(P<0.05),胰岛素敏感性降低(P<0.05),校正后发现空腹血糖、空腹胰岛素、HOMA-IR及SI与AHI独立相关(P<0.05).结论 青少年肥胖患者的OSAHS严重程度与空腹血糖水平呈正相关,与胰岛素敏感性呈负相关.%Objective To investigate the relationship between insulin resistance and the severity of obstructive sleep apnea hypopnea syndrome ( OSAHS) by comparing the clinical conditions of obese young adults with or without OSAHS. Methods A total of 250 obese young adults were collected consecutively from the specialized outpatient clinic for obesity in Ruijin Hospital. Polysomnography was applied to diagnose OSAHS and apnea hypopnea index ( AHI) to evaluate the severity of OSAHS. All subjects underwent a standard 75g oral glucose tolerance test (OGTT) in order to evaluate their glucose tolerance levels. Insulin resistance was determined by homeostasis model assessment of insulin resistance (HOMA-IR) and by the insulin sensitivity index (SI) derived from Bergman's minimal model. Results All subjects were divided into 4 groups according to AHI levels: non-OSAHS group, mild OSAHS group, moderate OSAHS group and severe OSAHS group. With the increasing of OSAHS severity, body mass index (BMI) , waist circumference, neck circumference, waist hip ratio, fasting blood glucose (FPG) , lipid profiles and hemoglobin Alc ( HbAlc) all increased (P <0. 05) but SI decreased (P <0.05). After adjustment for age and BMI, FPG, fasting insulin, HOMA-IR and SI were all independently associated with AHI levels. Conclusions The severity of OSAHS was positively associated with insulin resistance and negatively correlated with insulin sensitivity in obese young adults.