【摘要】： 目的：通過檢測阻塞性睡眠呼吸暫停低通氣綜合征(OSAHS)患者血清血管生成素樣蛋白4(Angpt14)水平,研究它與人體參數(shù)及脂代謝各指標的關(guān)系,探討Angpt14與OSAHS的關(guān)系及其在OSAHS發(fā)病機制中的作用。 方法：所有研究對象均來自于2009年4月至2010年1月在山西醫(yī)科大學(xué)第一醫(yī)院就診的患者,均行7小時多導(dǎo)睡眠圖(PSG)監(jiān)測系統(tǒng)進行監(jiān)測。按入院時間先后,選擇確診OSAHS的患者50例為OSAHS組。OSAHS患者根據(jù)《中華結(jié)核和呼吸雜志》2002年4月發(fā)表的“阻塞性睡眠呼吸暫停低通氣綜合征診治指南(草案)”確診,排除由小頜畸形、鼻中隔偏曲等解剖因素所致者,及糖尿病、高血壓病、冠心病、腦梗死、動脈粥樣硬化、腫瘤、手術(shù)應(yīng)激、慢性腎病、其他慢性缺氧性疾病,伴有心、腎功能衰竭等嚴重并發(fā)癥及正在口服降脂藥的病例。選擇年齡、民族、性別與相應(yīng)OSAHS患者匹配,PSG監(jiān)測未達到OSAHS診斷標準的正常人35名為健康對照組。分別采取OSAHS病例組及健康對照組的基線資料及清晨空腹靜脈血,酶聯(lián)免疫法測定OSAHS病例組和健康對照組的血清Angpt14水平,生化法測定血脂。最后進行相關(guān)統(tǒng)計分析。 結(jié)果：1.OSAHS組與健康對照組年齡、性別無顯著性差異(P＞0.05)。與健康對照組相比,OSAHS組頸圍、腹圍、BMI、腰髖比明顯增大(P0.01), TC、TG、LDL-C、Angpt14明顯升高(P0.01), HDL-C明顯降低(P0.01)。OSAHS組較健康對照組AHI、最低SO2＜90%時間明顯增加(p＜0.05),最低血氧飽和度及平均血氧飽和度較正常對照組顯著降低(p0.05)。 2.TG、LDL-C與AHI呈顯著正相關(guān),HDL-C與AHI呈負相關(guān)。控制BMI及年齡后,TG仍與AHI呈顯著正相關(guān)。 3.BMI、頸圍、腹圍、腰圍、臀圍、腰髖比均與AHI呈顯著正相關(guān)�？刂艬MI后,頸圍、腹圍、腰圍、腰髖比仍與AHI呈顯著正相關(guān)。 4. OSAHS組中血清Angpt14濃度與頸圍、腹圍、腰圍呈顯著正相關(guān)(P＜0.05),而與BMI、腰髖比無顯著相關(guān)性(P＞0.05)。OSAHS組中血清Angpt14濃度與AHI、最低SO2＜90%時間呈正相關(guān)(p＜0.05),與平均SO2、最低SO2呈顯著負相關(guān)(p＜0.05)。OSAHS組中血清Angpt14濃度與HDL-C呈顯著負相關(guān)(p＜0.05),與TG呈顯著正相關(guān)(p＜0.05),而與TC、LDL-C無顯著相關(guān)性。 結(jié)論：1. OSAHS與肥胖密切相關(guān),頸圍、腰圍、腹圍是OSAHS病情嚴重程度的獨立預(yù)測指標。OSAHS患者存在脂代謝紊亂,并且TG獨立于肥胖和年齡之外與AHI相關(guān),即高甘油三酯血癥越嚴重,OSAHS病情越嚴重。 2. OSAHS患者血清Angpt14明顯升高,且其濃度能反映OSAHS病情的嚴重程度及低氧血癥的嚴重程度。 3. Angpt14可能參與OSAHS患者脂代謝紊亂的形成。 4. OSAHS患者血清Angpt14水平與頸圍、腰圍、腹圍等正相關(guān),可能是Angpt14在不同部位脂肪組織中特異分布的結(jié)果。
[Abstract]:Objective: to study the relationship between serum angiopoietin-like protein 4 (Angpt14) and human parameters and lipid metabolism in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). To explore the relationship between Angpt14 and OSAHS and its role in the pathogenesis of OSAHS. Methods: all patients from April 2009 to January 2010 in the first Hospital of Shanxi Medical University were monitored by a 7-hour polysomnography (PSG) monitoring system. According to the time of admission, 50 patients with OSAHS were selected as OSAHS group. The diagnosis of OSAHS was confirmed according to the "guidelines for the diagnosis and treatment of obstructive sleep apnea hypopnea syndrome (OSAS)" published in April 2002 by the Chinese Journal of Tuberculosis and Respiratory. Excluded from anatomical factors such as maxillary malformation, nasal septum deviation, and diabetes, hypertension, coronary heart disease, cerebral infarction, atherosclerosis, tumor, surgical stress, chronic nephropathy, other chronic hypoxic diseases, accompanied by heart disease, Severe complications such as renal failure and ongoing oral lipid-lowering drugs. Age, nationality and sex were matched with the corresponding OSAHS patients. 35 normal subjects who did not meet the diagnostic criteria of OSAHS were selected as the healthy control group. The baseline data of OSAHS and healthy control group and the fasting venous blood in the morning were used respectively. The serum Angpt14 levels were measured by enzyme-linked immunosorbent assay (Elisa) and the serum lipids were measured by biochemical method. Finally, the related statistical analysis is carried out. Results: there was no significant difference in age and sex between 1.OSAHS group and healthy control group (P > 0. 05). Compared with the healthy control group, the neck circumference, abdominal circumference, BMI, waist hip ratio of OSAHS group increased significantly (P0.01), TC,TG,LDL-C,Angpt14 significantly increased (P0.01), and HDL-C decreased significantly (P0.01). OSAHS group than the healthy control group AHI,). The minimum SO2 < 90% time was significantly increased (p < 0. 05), and the minimum oxygen saturation and mean oxygen saturation were significantly lower than those in the normal control group (p < 0. 05). 2. There was a significant positive correlation between LDL-C and AHI, and a negative correlation between HDL-C and AHI. After the control of BMI and age, there was still a significant positive correlation between TG and AHI. 3. BMI, neck circumference, abdominal circumference, waist circumference, hip circumference and waist hip ratio were positively correlated with AHI. After BMI control, neck circumference, abdominal circumference and waist hip ratio were still positively correlated with AHI. 4. Serum Angpt14 concentration was positively correlated with neck circumference, abdominal circumference and waist circumference in OSAHS group (P < 0. 05), but had no significant correlation with BMI, waist hip ratio (P > 0. 05). OSAHS). The minimum SO2 < 90% time was positively correlated (p < 0. 05), and negatively correlated with the mean SO2, minimum SO2 (p < 0. 05). The serum Angpt14 concentration was negatively correlated with HDL-C in the). OSAHS group (p < 0. 05). There was a significant positive correlation with TG (p < 0. 05), but no significant correlation with TC,LDL-C. Conclusion 1. OSAHS is closely related to obesity. Neck circumference, waist circumference and abdominal circumference are independent predictors of the severity of OSAHS. There is lipid metabolism disorder in OSAHS patients, and TG is associated with AHI independently of obesity and age, that is, hypertriglyceridemia is more serious. The more serious OSAHS is, the more serious it is. 2. The serum Angpt14 level in OSAHS patients was significantly increased, and its concentration could reflect the severity of OSAHS and hypoxemia. 3. Angpt14 may be involved in the formation of lipid metabolism disorder in patients with OSAHS. 4. The serum Angpt14 level in OSAHS patients was positively correlated with neck circumference, waist circumference and abdominal circumference, which may be the result of specific distribution of Angpt14 in adipose tissue of different parts.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號】：R766

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本文編號：2333368