阻塞性睡眠呼吸暂停低通气综合征患者血清apelin的变化及相关因素分析

发布时间：2018-06-01 13:19

本文选题：OSAS + apelin　；参考：《山西医科大学》2012年硕士论文

【摘要】：目前有学者将OSAS归为代谢综合症(MS)的一部分,而MS的中心环节是IR。Apelin系孤独G蛋白偶联受体-血管紧张素受体AT1有关的受体蛋白(oGPCR APJ)的内源性配体。Apelin/APJ系统普遍存在于人体内许多系统,有多种生物效应,例如：调节下丘脑-垂体激素分泌、抑制抗利尿激素分泌、降低血压、增加心肌收缩力等作用。近年发现它是一种有生物活性的肽类激素,且是一种新发现的脂肪细胞因子,和肥胖及IR有关,但其中的具体作用机制没有完全探明。而OSAS患者血清apelin水平及其相关因素的研究不多,相关报道也甚为少见。本实验拟通过检测OSAS患者空腹血糖、血清apelin和胰岛素水平及相关分析,探讨OSAS患者血清apelin水平及分析其相关因素。一、OSAS和肥胖病人apelin水平及相关因素分析方法：研究对象123例,63例为2010年10月—2011年11月因睡眠打鼾、白天嗜睡在山西医科大学呼吸睡眠中心就诊的患者,60例为体健中心就诊者,全部进行睡眠多导图(PSG)监测,AHI≥5为OSAS诊断标准。分成4组：A组肥胖OSAS患者32例(BMI≥28,AHI5)：B组非肥胖OSAS患者31例(BMI25,AHI5)：C组单纯肥胖30例(BMI≥28,AHI5)：D组对照30例(BMI25,AHI5)。FBG及FINS分别采用葡萄糖氧化酶法及放免法测定,apelin用ELISA法测定,根据FBG及FINS计算稳态模式估计法胰岛素敏感指数(HOMA-IR),利用相关分析判断OSAS患者血清apelin与FINS、HOMA-IR等的关系。结果：第一部分(1.)A、B、C和D组FBG分别为：5.60±0.26mmol/L、5.75±0.37mmol/L、5.67±0.30mmol/L和5.21±0.46mmol/L,FINS分别为：16.61±1.93mU/L、11.36±1.53mU/L、11.17±1.71mU/L和9.13±1.07mU/L。与D组比较,A、B和C组FBG和FINS均显著增高(P0.05~0.01)；三组之间FBG的比较无显著差异(P0.05),且A组FINS非常显著高于B组和C组(P0.01)。(2)四组apelin分别为：424.9±20.9ng/L、379.5±25.3ng/L、389.4±18.3ng/L和360.3±15.4ng/L；与D组比较,A、B和C组apelin均显著增高(P0.05~0.01),且A组apelin非常显著高于B和C组(P0.01)。(3)四组ln(HOMA-IR)分别为：1.41±0.17、1.05±0.15、1.02±0.20和0.74±0.13：与D组比较,A、B和C组HOMA-IR均显著增高(P0.05),且A组显著高于C组(P0.05)。(4)多变量偏相关分析显示所有OSAS患者血清apelin与FINS、ln(HOMA-IR)成正相关,相关系数分别为：0.404(p0.01)、0.759(p0.01)。二.不同程度OSAS患者血清apelin水平及影响因素方法：研究对象40例均为2011年03月—2011年11月因睡眠打鼾、白天嗜睡在山西医科大学第二医院呼吸睡眠中心就诊的鼾症患者,全部用多导睡眠图(PSG)进行睡眠呼吸监测并测量其体重、身高。均为男性,年龄32-57岁,平均45.7±9.1岁。根据AHI分为三组：(1)中重度OSAS组(AHI≥20)16例；(2)轻度组(AHI5～20)14例；(3)正常对照组10例(AHI5)。FBG及FINS分别采用葡萄糖氧化酶法及放免法测定,apelin用ELISA法测定,根据FBG及FINS计算稳态模式估计法胰岛素敏感指数(HOMA-IR),利用相关分析判断OSAS患者血清apelin与FINS、HOMA-IR等的关系。结果：(1)A、B和C组FBG分别为：5.64±0.38mmol／L.5.60±0.54mmol／L和5.16±0.59mmol/L,与C组比较,A和B组FBG均显著增高(P0.05),但两组之间比较无显著差异(P0.05)；三组FINS分别为：16.36±3.14mU/L、11.42±1.85mU/L和8.95±1.56mU/L与C组比较,A和B组FINS非常显著增高(P0.01),且A组FINS也非常显著高于B组(P0.01)。(2)三组apelin分别为：426.3±35.0ng/L、392.2±31.1ng/L和360.2±23.4ng/L,与C组比较,A和B组apelin非常显著增高(P0.01),且A组apelin也非常显著高于B组(P0.01)。(3)三组HOMA-IlR分别为：4.12±0.94、2.84±0.56和2.07±0.53,FBCI分别为：2.9±0.51、2.06±0.38和1.72±0.24,与C组比较,A和B组的HOMA-IR和FBCI均显著增高(P0.05～0.01),且A组的HOMA-IR和FBCI非常显著高于B组(P0.01):(4)OSAS患者apelin与BMI、FINS、HOMA-IR和FBCI成正相关,相关系数分别为：0.4994(P0.01)、0.3336(P0.05)、0.5790(P0.01)和0.5771(P0.01)。结论：1.肥胖和OSAS均可引起血清apelin水平升高,两者之间无交互作用。2.OSAS患者血清apelin较肥胖和正常对照组高,并且随病情加重,apelin升高更明显。3.OSAS患者HOMA-IR和血清FINS较肥胖和正常对照组升高,提示OSAS患者存在胰岛素抵抗,并且随着AHI的升高,胰岛素抵抗越明显。4.OSAS血清apelin水平可能与其IR有关。
[Abstract]:At present, some scholars classify OSAS into a part of metabolic syndrome (MS), and the central link of MS is the endogenous ligand.Apelin/APJ system of the IR.Apelin system, the endogenous ligand of the receptor protein (oGPCR APJ) associated with the receptor of the angiotensin receptor AT1 (oGPCR APJ), which is commonly found in many human bodies and has a variety of biological effects, such as regulating hypothalamus hypothalamus. The secretion of body hormone, inhibiting the secretion of antidiuretic hormone, lowering blood pressure and increasing the myocardial contractility. It has been found to be a bioactive peptide hormone in recent years, and it is a newly discovered adipocytokine, which is related to obesity and IR, but the specific mechanism of action is not fully explored. And the level of serum Apelin and its correlation in OSAS patients The study of the factors is rare and the related reports are rare. This experiment is to explore the level of serum Apelin and the related factors in the patients with OSAS by detecting the fasting blood glucose of the OSAS patients, the serum Apelin and insulin level and the related analysis.
Analysis of Apelin level and related factors in OSAS and obese patients
Methods: 123 cases were studied, 63 cases were snoring in October 2010 to November 2011, and 60 patients were snoring and sleep center in Shanxi Medical University, 60 cases were body health centers. All of them were monitored by sleep polygraph (PSG) and AHI > 5 were OSAS diagnostic criteria. 32 cases of obese OSAS patients (BMI > 28, AHI5):B were divided into group A. Groups of 31 non obese OSAS patients (BMI25, AHI5):C were simple obesity (BMI > 28, AHI5):D group, 30 cases (BMI25, AHI5).FBG and FINS were determined by glucose oxidase method and radioimmunoassay respectively. The relationship between serum Apelin and FINS, HOMA-IR and so on.
Results: the first part (1.) A, B, C and D group FBG were 5.60 + 0.26mmol/L, 5.75 + 0.37mmol/L, 5.67 + 0.30mmol/L and 5.21 + 0.46mmol/L respectively. FINS was 16.61 + 1.93mU/L, 11.36 + 1.53mU/L, 11.17 and 9.13 +. The difference (P0.05) and A group FINS were significantly higher than that of group B and C group (P0.01). (2) the four groups of Apelin were 424.9 + 20.9ng/L, 379.5 + 25.3ng/L, 389.4 + 18.3ng/L and 360.3 + 15.4ng/L. 41 + 0.17,1.05 + 0.15,1.02 + 0.20 and 0.74 + 0.13: compared with group D, HOMA-IR in A, B and C groups increased significantly (P0.05), and A group was significantly higher than C group (P0.05). (4) multivariate partial correlation analysis showed that all OSAS patients were positively correlated with 0.404 (0.404), 0.759 (0.759).
Two. Serum Apelin level and its influencing factors in patients with different degrees of OSAS
Methods: 40 snorers who snored from 03 months to November 2011 from 2011 to November 2011 were snoring patients at the respiratory sleep center of the second hospital of Shanxi Medical University. All of them were monitored by polysomnography (PSG) and measured their body weight and height. All were male, age 32-57 years, and average 45.7 + 9.1 years. According to AHI points, Three groups were: (1) 16 cases of moderate to severe OSAS (AHI > 20); (2) mild group (AHI5 to 20) 14 cases; (3) 10 cases of normal control group (AHI5).FBG and FINS were measured by glucose oxidase method and radioimmunoassay respectively. Apelin was determined by ELISA method. The insulin sensitivity index (HOMA-IR) was calculated according to FBG and FINS, and the correlation analysis was used to judge OSAS. The relationship between serum Apelin and FINS, HOMA-IR and so on.
Results: (1) A, B and C group FBG were respectively: 5.64 + 0.38mmol / L.5.60 + L and 5.16 + 0.59mmol/L respectively. Compared with C group, A and B groups were significantly higher, but there was no significant difference between the two groups. The three groups were 16.36 +, 11.42 and 8.95. High (P0.01), and group A FINS was also significantly higher than group B (P0.01). (2) three groups of Apelin were 426.3 + 35.0ng/L, 392.2 + 31.1ng/L and 360.2 + 23.4ng/L, and A and B groups were significantly higher than C groups. (3) three groups were 4.12 + 360.2 + 0.56 and 2.07 + 0.53, respectively. I was 2.9 + 0.51,2.06 + 0.38 and 1.72 + 0.24 respectively. Compared with C group, HOMA-IR and FBCI were significantly higher in A and B groups (P0.05 ~ 0.01), and HOMA-IR and FBCI in A group were significantly higher than those in B group. (4) the correlation coefficients were 0.4994, 0.3336, 0.5790 and 0.5, respectively. 771 (P0.01).
Conclusion: 1. obesity and OSAS can cause the increase of serum Apelin level. The serum Apelin of patients with.2.OSAS without interaction is higher than that of obesity and normal control group, and with the aggravation of the disease, the increase of Apelin in.3.OSAS patients and the increase of HOMA-IR and serum FINS are more than that of the obese and normal control group, suggesting the presence of insulin resistance in the OSAS patients. With the increase of AHI, insulin resistance is more obvious..4.OSAS serum Apelin level may be related to IR.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R56

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