【摘要】：目的阻塞性睡眠呼吸暫停低通氣綜合征(Obstructive Sleep Apnea Hypopnea Syndrome,OSAHS)是一種嚴(yán)重危害人們身體健康并降低生活質(zhì)量甚至威脅生命的臨床常見(jiàn)疾病。常伴有胰島素抵抗、交感神經(jīng)興奮、氧化應(yīng)激、慢性炎癥反應(yīng),是肥胖、2型糖尿病、代謝綜合征常見(jiàn)合并癥。有研究顯示,2型糖尿病患者中,OSAHS的患病率逐年增加,糾正夜間通氣可以改善胰島素抵抗,降低交感神經(jīng)興奮,降低血壓。目前,多導(dǎo)睡眠監(jiān)測(cè)是診斷OSAHS的金標(biāo)準(zhǔn),但其價(jià)格昂貴,依從性差。所以對(duì)于選取常用測(cè)量指標(biāo)篩選和診斷阻塞性睡眠呼吸暫停綜合征具有簡(jiǎn)單、易行的臨床指導(dǎo)意義。本文通過(guò)測(cè)量2型糖尿病伴打鼾患者頸圍、頸長(zhǎng)、體脂成分,分析其與呼吸暫停低通氣指數(shù)(Apnea Hyponea Index,AHI)的相關(guān)性。方法選取2015年1月至2016年9月于我院內(nèi)分泌科住院2型糖尿病患者并夜間睡眠打鼾者136例,對(duì)其測(cè)量頸圍、頸長(zhǎng)、體脂成分等指標(biāo),以及利用多導(dǎo)睡眠圖監(jiān)測(cè)(PSG)測(cè)量AHI、氧減指數(shù)(ODI)、最低血氧飽和度等指標(biāo),依據(jù)AHI分為非OSAHS、輕度、中度、重度四組(5、5~15、15~30、≥30次/h),分析組間BMI、腰圍、臀圍、頸圍、頸長(zhǎng)、體脂成分指標(biāo)與AHI的相關(guān)性,同時(shí)對(duì)各指標(biāo)進(jìn)行Logistic回歸分析。結(jié)果2型糖尿病伴OSAHS組與2型糖尿病非OSAHS組之間比較,空腹血糖、血壓、血脂、血清尿酸組間無(wú)統(tǒng)計(jì)學(xué)差異(P0.05);頸圍具有統(tǒng)計(jì)學(xué)差異(t=-2.185,P=0.031),經(jīng)身高校正的頸圍仍具有統(tǒng)計(jì)學(xué)意義(t=-2.705,P0.05);依據(jù)AHI分4組后,組間比較BMI、頸圍、頸長(zhǎng)與OSAHS的嚴(yán)重程度呈正相關(guān)(P0.05)。在男性,內(nèi)臟脂肪指數(shù)、身體脂肪率、皮下脂肪指數(shù)與OSAHS的嚴(yán)重程度有關(guān)系,且重度OSAHS組在以上指標(biāo)較輕、中度OSAHS組大,在男性,組間比較有統(tǒng)計(jì)學(xué)差異(P0.05),而在女性,組間比較無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。采用受試者工作特征(receiver operating characteristic curve,ROC)曲線(xiàn)判斷,預(yù)測(cè)OSAHS頸圍的最佳切點(diǎn)為41.2cm,敏感性和特異性分別為56.9%和70%,曲線(xiàn)下面積為0.646(95%CI 0.564~0.727);預(yù)測(cè)OSAHS的頸長(zhǎng)的最佳切點(diǎn)為6.5cm,敏感性和特異性分別為62.5%和70%,曲線(xiàn)下面積為0.606(95%CI 0.529~0.683)。各指標(biāo)進(jìn)行Logistic回歸分析顯示,頸圍、頸長(zhǎng)是OSAHS患病風(fēng)險(xiǎn)獨(dú)立正相關(guān)(P0.05,OR=3.905)、(P0.05,OR=4.841)。結(jié)論頸圍、頸長(zhǎng)是2型糖尿病患者合并OSAHS的獨(dú)立危險(xiǎn)因素。區(qū)分性別后發(fā)現(xiàn),在男性,頸長(zhǎng)是其獨(dú)立危險(xiǎn)因素,頸長(zhǎng)越長(zhǎng)越易出現(xiàn)OSAHS并且OSAHS程度越嚴(yán)重;而在女性,頸圍是其獨(dú)立危險(xiǎn)因素,頸圍越粗越易出現(xiàn)OSAHS且OSAHS程度越嚴(yán)重。本文通過(guò)分析得出頸圍、頸長(zhǎng)篩選OSAHS的最佳切點(diǎn),這為臨床工作中篩選OSAHS提供了輔助手段。意義本文通過(guò)分析2型糖尿病合并阻塞性睡眠呼吸暫停綜合征患者頸圍、頸長(zhǎng)及體脂成分與呼吸低通氣指數(shù)(AHI)的相關(guān)性,發(fā)現(xiàn)頸圍、頸長(zhǎng)與睡眠呼吸暫停有關(guān)系。同時(shí),分析得出頸圍、頸長(zhǎng)篩選OSAHS的最佳切點(diǎn),這為臨床工作中篩選OSAHS提供了輔助手段。
[Abstract]:Objective obstructive sleep apnea hypopnea syndrome (Obstructive Sleep Apnea Hypopnea Syndrome OSAHS) is a common clinical disease which seriously endangers people's health and reduces the quality of life and even threatens life. Often accompanied by insulin resistance, sympathetic excitement, oxidative stress, chronic inflammatory response, obesity type 2 diabetes mellitus, metabolic syndrome is common complications. Some studies have shown that the prevalence of OSAHS in patients with type 2 diabetes is increasing year by year. Correcting nocturnal ventilation can improve insulin resistance, reduce sympathetic excitement and lower blood pressure. At present, polysomnography is the gold standard for diagnosis of OSAHS, but its price is high and compliance is poor. So it is simple and easy to select and diagnose obstructive sleep apnea syndrome (OSAS). By measuring the neck circumference, neck length and body fat composition of type 2 diabetes mellitus patients with snoring, the relationship between the neck circumference, neck length and apnea hypopnea index (Apnea Hyponea Indexa AHI) was analyzed. Methods from January 2015 to September 2016, 136 patients with type 2 diabetes mellitus and nocturnal sleep snoring were selected and their neck circumference, neck length and body fat composition were measured. The (PSG) was measured by polysomnography, the oxygen reductive index (ODI),) and the lowest oxygen saturation were measured. According to AHI, the patients were divided into four groups: non-OSAS, mild, moderate and severe (5 / 5, 1515, 1530, 鈮，

本文編號(hào)：2193324