【摘要】：目的：觀察阻塞性睡眠呼吸暫停低通氣綜合征(OSAHS)及OSAHS合并2型糖尿病(T2DM)患者血清單核細(xì)胞趨化蛋白-1(MCP-1)、胱抑素C（Cys C）的變化，探討它們?cè)贠SAHS及其合并T2DM發(fā)病過程中可能的作用機(jī)制。分析經(jīng)鼻持續(xù)氣道內(nèi)正壓通氣（nCPAP）治療對(duì)OSAHS合并T2DM患者血清MCP-1、Cys C及血糖水平的影響。 方法：選取2010年10月至2011年7月在我院就診，并行不少于7小時(shí)多導(dǎo)睡眠圖監(jiān)測(cè)（PSG）及快速空腹血糖（FPG）檢測(cè)。診斷標(biāo)準(zhǔn)參照《阻塞性睡眠呼吸暫停低通氣綜合征診治指南（草案）》、《中國2型糖尿病防治指南》。所有研究對(duì)象的性別、年齡、體重指數(shù)（BMI）間有均衡性，均排除心、腦、腎、肺、肝臟等重要臟器的器質(zhì)性改變，均簽署知情同意書。分為OSAHS合并T2DM組(OD組)、單純OSAHS組（O組）、單純T2DM組（DM組）、正常對(duì)照組（N組）4組，每組各28例，采用酶聯(lián)免疫法（ELISA）檢測(cè)各組研究對(duì)象血清MCP-1、Cys C的水平。另選取20例中重度OSAHS合并T2DM患者接受1月經(jīng)鼻持續(xù)氣道正壓通氣（nCPAP）治療后，再次檢測(cè)血清MCP-1、Cys C的水平。最后進(jìn)行相關(guān)統(tǒng)計(jì)分析。 結(jié)果：1.與N組研究對(duì)象比較，O組、DM組、OD組患者血清MCP-1、Cys C水平升高（均P0.05），OD組水平最高。O組與DM組患者血清MCP-1、Cys C比較差異無顯著性（均P0.05）。 2.OD組患者血清MCP-1、Cys C水平較治療前下降（均P0.05）。 3.血清MCP-1水平與呼吸暫停指數(shù)（AHI）呈正相關(guān)，與最低血氧飽和度（LSO2）、平均血氧飽和度（MSO2）呈負(fù)相關(guān)；血清Cys C水平與AHI呈正相關(guān)，與LSO2、MSO2呈負(fù)相關(guān)(均P0.05)。 4.血清MCP-1、Cys C與FPG呈正相關(guān)(均P0.05)。 結(jié)論：1.血清MCP-1、Cys C可能參與OSAHS合并T2DM的發(fā)生發(fā)展。 2.血清MCP-1、Cys C水平的變化可反映OSAHS患者病情嚴(yán)重程度及低氧血癥嚴(yán)重程度。 3.nCPAP治療可改善OSAHS合并T2DM患者的病情，使MCP-1、Cys C水平下降，從而起到一定的治療作用。
[Abstract]:Objective: to observe the changes of monocyte chemoattractant protein 1 (MCP-1) and cystatin C (Cys C) in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and OSAHS with type 2 diabetes mellitus (T2DM), and to explore their possible mechanism in the pathogenesis of OSAHS and T2DM. To analyze the effect of nasal continuous positive airway pressure ventilation (nCPAP) on serum MCP-1C and blood glucose levels in patients with OSAHS complicated with T2DM. Methods: (PSG) and fast fasting blood glucose (FPG) were detected by polysomnography and fast fasting blood glucose in our hospital from October 2010 to July 2011. Diagnostic criteria refer to the guidelines for the diagnosis and treatment of obstructive sleep apnea hypopnea syndrome (draft) and Chinese guidelines for the prevention and treatment of type 2 diabetes. Gender, age and body mass index (BMI) of all subjects were balanced, and the organic changes of heart, brain, kidney, lung, liver and other important organs were excluded, and informed consent was signed. OSAHS combined with T2DM (OD group), simple OSAHS group (O group), simple T2DM group (DM group) and normal control group (N group) were divided into 4 groups (28 cases in each group). The serum MCP-1Cys C levels were detected by enzyme-linked immunosorbent assay (ELISA). In addition, 20 patients with moderate and severe OSAHS combined with T2DM were treated with nasal continuous positive airway pressure (nCPAP) in January, and the serum MCP-1Cys C levels were determined again. Finally, the related statistical analysis is carried out. The result is 1: 1. Compared with group N, the serum MCP-1Cys C level in DM group (P 0.05) was higher than that in group N (P 0.05). There was no significant difference between group O and DM group (P 0.05). There was no significant difference between group O and group DM (P0.05). The level of serum MCP-1cys C in patients with 2.OD was higher than that in patients with diabetes mellitus (P 0.05). Before the decrease (P0.05). 3. Serum MCP-1 level was positively correlated with apnea index (AHI), negatively correlated with minimum oxygen saturation (LSO2) and mean oxygen saturation (MSO2), and serum Cys C level was positively correlated with AHI and negatively correlated with LSO _ 2M _ 2 _ 2 (P0.05). There was a positive correlation between serum MCP-1 and FPG (P 0.05). Conclusion 1. Serum MCP-1 Cys C may be involved in the occurrence and development of OSAHS combined with T2DM. 2. The change of serum MCP-1Cys C level can reflect the severity of OSAHS and hypoxemia. 3.nCPAP treatment can improve the condition of OSAHS patients with T2DM and decrease the level of MCP-1Cys C, and thus play a therapeutic role.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R766;R587.1

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