【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疾病。常伴有胰島素抵抗、交感神經(jīng)興奮、氧化應激、慢性炎癥反應,是肥胖、2型糖尿病、代謝綜合征常見合并癥。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,多導睡眠監(jiān)測是診斷OSAHS的金標準,但其價格昂貴,依從性差。所以對于選取常用測量指標篩選和診斷阻塞性睡眠呼吸暫停綜合征具有簡單、易行的臨床指導意義。本文通過測量2型糖尿病伴打鼾患者頸圍、頸長、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,對其測量頸圍、頸長、體脂成分等指標,以及利用多導睡眠圖監(jiān)測(PSG)測量AHI、氧減指數(shù)(ODI)、最低血氧飽和度等指標,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、體脂成分指標與AHI的相關(guān)性,同時對各指標進行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、血清尿酸組間無統(tǒng)計學差異(P0.05);頸圍具有統(tǒng)計學差異(t=-2.185,P=0.031),經(jīng)身高校正的頸圍仍具有統(tǒng)計學意義(t=-2.705,P0.05);依據(jù)AHI分4組后,組間比較BMI、頸圍、頸長與OSAHS的嚴重程度呈正相關(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的嚴重程度有關(guān)系,且重度OSAHS組在以上指標較輕、中度OSAHS組大,在男性,組間比較有統(tǒng)計學差異(P0.05),而在女性,組間比較無統(tǒng)計學差異(P0.05)。采用受試者工作特征(receiver operating characteristic curve,ROC)曲線判斷,預測OSAHS頸圍的最佳切點為41.2cm,敏感性和特異性分別為56.9%和70%,曲線下面積為0.646(95%CI 0.564~0.727);預測OSAHS的頸長的最佳切點為6.5cm,敏感性和特異性分別為62.5%和70%,曲線下面積為0.606(95%CI 0.529~0.683)。各指標進行Logistic回歸分析顯示,頸圍、頸長是OSAHS患病風險獨立正相關(guān)(P0.05,OR=3.905)、(P0.05,OR=4.841)。結(jié)論頸圍、頸長是2型糖尿病患者合并OSAHS的獨立危險因素。區(qū)分性別后發(fā)現(xiàn),在男性,頸長是其獨立危險因素,頸長越長越易出現(xiàn)OSAHS并且OSAHS程度越嚴重;而在女性,頸圍是其獨立危險因素,頸圍越粗越易出現(xiàn)OSAHS且OSAHS程度越嚴重。本文通過分析得出頸圍、頸長篩選OSAHS的最佳切點,這為臨床工作中篩選OSAHS提供了輔助手段。意義本文通過分析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、頸長與睡眠呼吸暫停有關(guān)系。同時,分析得出頸圍、頸長篩選OSAHS的最佳切點,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：2193324