本文選題：阻塞性睡眠呼吸暫停綜合征 + 高同型半胱氨酸血癥��； 參考：《汕頭大學(xué)》2010年碩士論文

【摘要】：引言阻塞性睡眠呼吸暫停綜合征(obstructive sleep apnea syndrome,OSAS)是一種常見的睡眠呼吸障礙。近年研究表明,OSAS與腦梗死及腦梗死的多種危險(xiǎn)因素如高血壓、糖尿病、心房纖顫等密切相關(guān)。已發(fā)現(xiàn)OSAS患者體內(nèi)存在胰島素抵抗;據(jù)研究,胰島素抵抗可引起高同型半胱氨酸血癥(Hyperhomocysteinemia,HHcy),而HHcy是腦梗死的獨(dú)立危險(xiǎn)因素。那么,OSAS是否可能通過胰島素抵抗影響同型半胱氨酸(Homocysteine,Hcy)的代謝,進(jìn)而導(dǎo)致腦梗死的發(fā)生呢?經(jīng)檢索目前尚無這方面的報(bào)道。本研究擬通過觀察OSAS患者體內(nèi)胰島素抵抗及Hcy水平,分析OSAS、胰島素抵抗和Hcy之間的關(guān)系,進(jìn)一步探討OSAS患者HHcy及腦梗死發(fā)生的可能機(jī)制。 材料與方法入選者為于2009年1月~2009年9月在北京大學(xué)深圳醫(yī)院干部病房行睡眠呼吸監(jiān)測(cè)的住院或門診病人。對(duì)入選者用Epworth嗜睡量表(Epworth sleepiness scale,ESS)進(jìn)行嗜睡評(píng)分。按照便攜式睡眠呼吸監(jiān)測(cè)儀的監(jiān)測(cè)結(jié)果,將入選者分為OSAS組(n=22)與對(duì)照組(n=20)。在多導(dǎo)睡眠監(jiān)測(cè)完成的當(dāng)天檢測(cè)其空腹血清Hcy、血糖、血清胰島素及血脂,計(jì)算出體內(nèi)穩(wěn)態(tài)模式評(píng)估下的胰島素抵抗指數(shù)(Homeostasis model assessment of insulin resistance,HOMA-IR),HOMA-IR=空腹胰島素(μIU/ml))×空腹血糖(mmol/L)/22.5。比較OSAS組同對(duì)照組血清Hcy及HOMA-IR水平,探討Hcy與呼吸暫停低通氣指數(shù)(apnea hypopnea index,AHI)、HOMA-IR與AHI、Hcy與HOMA-IR的關(guān)系。 實(shí)驗(yàn)結(jié)果OSAS組的血清Hcy、HOMA-IR較對(duì)照組高[(18.043±6.967,11.835±4.156)μmol/L,P0.05;(4.510±2.877,2.755±1.124),P0.05]。OSAS患者中,Hcy、HOMA-IR與AHI呈正性相關(guān)[ (r=0.779,P0.01),(r=0.845,P0.01)],經(jīng)偏相關(guān)分析校正體重指數(shù)(Bodymass index,BMI)及年齡的影響后,Hcy、HOMA-IR與AHI仍呈正相關(guān)([r'=0.525,P'0.05),(r'=0.725,P'0.01)];在OSAS組,Hcy與HOMA-IR呈正相關(guān)(r=0.815,P0.01),經(jīng)偏相關(guān)分析校正BMI及年齡后,Hcy與HOMA-IR仍呈明顯的正相關(guān)(r'=0.715,P'0.01)。 結(jié)論OSAS組Hcy、HOMA-IR水平較對(duì)照組高(P0.05)。Hcy、HOMA-IR均與OSAS的嚴(yán)重程度呈正相關(guān)(P均0.01),Hcy水平與HOMA-IR呈正相關(guān)(P0.01)。OSAS可能通過引起胰島素抵抗而影響Hcy的代謝,引起高同型半胱氨酸血癥,導(dǎo)致腦梗死的發(fā)生。
[Abstract]:Obstructive sleep apnea syndrome (OSAS) is a common disorder of sleep apnea. In recent years, studies have shown that OSAS is closely related to a variety of risk factors for cerebral infarction and cerebral infarction such as hypertension, diabetes, and atrial fibrillation. The presence of insulin resistance in OSAS patients has been found; according to the study, the pancreas is studied. Isle resistance can cause hyperhomocysteinemia (Hyperhomocysteinemia, HHcy), and HHcy is an independent risk factor for cerebral infarction. Then, is OSAS possible to affect the metabolism of homocysteine (Homocysteine, Hcy) by insulin resistance and lead to the occurrence of cerebral infarction? This study has not been reported. By observing the insulin resistance and the level of Hcy in OSAS patients, the relationship between OSAS, insulin resistance and Hcy was analyzed, and the possible mechanism of HHcy and cerebral infarction in OSAS patients was further explored.
Materials and methods were hospitalized or outpatient patients in the Shenzhen hospital cadre ward of Shenzhen Hospital of Peking University in September January 2009. The drowsiness scores were measured by the Epworth sleepiness scale (ESS). The participants were divided into OSAS group according to the monitoring results of the portable sleep monitor. N=22) and the control group (n=20). On the day of completion of polysomnography, the fasting serum Hcy, blood glucose, serum insulin and blood lipid were measured, and the insulin resistance index (Homeostasis model assessment of insulin resistance, HOMA-IR), HOMA-IR= fasting insulin (IU/ml)) by the homeostasis model of the body was calculated. The serum levels of Hcy and HOMA-IR in the OSAS group were compared with those in the control group, and the relationship between Hcy and apnea hypopnea index (apnea hypopnea index, AHI), HOMA-IR and AHI, Hcy and HOMA-IR were compared.
The serum Hcy and HOMA-IR in OSAS group were higher than those of the control group [(18.043 + 6.967,11.835 + 4.156) mu mol/L, P0.05; (4.510 + 2.877,2.755 + 1.124). In P0.05].OSAS patients, Hcy, HOMA-IR and AHI were positively related [(r=0.779,]]). A-IR is still positively correlated with AHI ([r'=0.525, P'0.05), (r'=0.725, P'0.01)); in OSAS group, Hcy and HOMA-IR are positively correlated (r=0.815, P0.01). After correction of BMI and age by partial correlation analysis, there is still a significant positive correlation.
Conclusion the level of Hcy and HOMA-IR in OSAS group is higher than that of the control group (P0.05).Hcy, HOMA-IR is positively correlated with the severity of OSAS (P 0.01), Hcy level is positively correlated with HOMA-IR (P0.01).OSAS may affect metabolism by causing insulin resistance, causing hyperhomocysteinemia, causing cerebral infarction.

【學(xué)位授予單位】：汕頭大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類號(hào)】：R766

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