男性肥胖型与非肥胖型 OSAHS 和胰岛素抵抗的相关分析

摘要

目的：探讨男性肥胖型与非肥胖型阻塞性睡眠呼吸暂停低通气综合征（OSAHS）与胰岛素抵抗（IR）之间的关系。方法将因睡眠呼吸问题而就诊的88例男性患者纳入研究，根据多导睡眠图（PSG）、BMI 及睡眠呼吸暂停低通气指数（AHI）将88例分为非肥胖型 OSAHS 组28例（OSAHS 轻度组10例，中重度组18例）、肥胖型 OSAHS 组26例（轻度组10例，中重度组16例）、单纯肥胖组18例和对照组16例。测定各组空腹血糖、空腹胰岛素（FINS）、总胆固醇、甘油三酯、LDL-C、HDL-C，并计算胰岛素抵抗指数（HOMA-IR），比较各组的上述指标，并采用 Pearson 相关与多重线性逐步回归分析 AHI 与各指标间、HOMA-IR 与各指标间的相关性。结果肥胖型 OSAHS 组的空腹血糖、FINS、HOMA-IR、总胆固醇、甘油三酯、LDL-C 水平均高于单纯肥胖组（P 均＜0.05），非肥胖型 OSAHS 组上述指标的水平也均高于对照组（P 均＜0.05）。中重度 OSAHS 组的糖脂异常、IR 程度均较相应的轻度组严重（P 均＜0.05）。OSAHS 患者的 AHI 与 HOMA-IR、总胆固醇、甘油三酯、LDL-C 均呈正相关（P 均＜0.05）；非肥胖型 OSAHS 组中影响 AHI 的因素是 HOMA-IR，影响HOMA-IR 的因素是 AHI。结论在男性患者中，OSAHS 与 IR 相关且独立于肥胖因素，IR 程度随着OSAHS 病情的加重而增加。%Objective To investigate the relationship between obstructive sleep apnea-hypopnea syn-drome (OSAHS)and insulin resistance (IR)in obese or non-obese male patients.Methods According to polysomnography (PSG),body mass index (BMI)and apnea hypopnea index (AHI),88 patients with sleep-related breathing disorders were divided into four groups:non-obese OSAHS group (n =28;1 0 with mild and 1 8 with moderate and severe OSAHS),obese OSAHS group (n =26;1 0 with mild and 1 6 with moderate and severe OSAHS),obese group (n =1 8)and control group (n =1 6).Fasting glucose,fasting insulin (FINS), serum total cholesterol,triglyceride,low density lipoprotein (LDL-C),high density lipoprotein (HDL-C)were measured and insulin resistance index (HOMA-IR) was calculated and statistically compared among all groups.The correlation between AHI and each index,and between HOMA-IR and each index was analyzed by Pearson correlation and multiple linear regression analyses.Results The levels of fasting glucose,FINS,HO-MA-IR,serum total cholesterol,triglyceride and LDL-C in the obese OSAHS group were significantly higher than those in the obese group (all P <0.05).The same difference was observed between the non-obese OS-AHS and control groups (all P <0.05).Patients with moderate and severe OSAHS had more severe glucose and lipid metabolism abnormality and IR compared with their counterparts with mild OSAHS (both P <0.05).In the OSAHS patients,AHI was positively correlated with HOMA-IR,serum total cholesterol,triglyceride and LDL-C (all P <0.05).In the non-obese OSAHS group,HOMA-IR was the major factor influencing AHI and AHI was also the major influencing factor of HOMA-IR.Conclusions In male OSAHS patients,OSAHS was closely correlated with IR independent of obesity.The severity of IR was deteriorated over the aggravation of OSAHS.