代谢综合征伴阻塞性睡眠呼吸暂停综合征患者与血清脂联素、和肽素及铁调素的相关性研究

发布时间：2018-08-15 12:03

【摘要】：目的:本文研究代谢综合征伴阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者与脂联素(APN)、和肽素(Cop)、铁调素(Hep)之间的相关性,进一步阐明脂联素、和肽素及铁调素在OSAHS发病过程中的作用,探讨其能否成为对OSAHS患者提供临床评估、预后及疗效评估的生物学指标。方法:本研究随机选取从2015年4月-2015年11月就诊于兰州大学第二医院糖尿病一科经多导睡眠描记仪(PSG)监测的患者共44例,其中明确诊断为OSAHS的患者40例(轻度30例,中度5例,重度5例),同时于兰州大学第二医院体检中心选取无打鼾的健康人30例作为正常对照组。监测OSAHS患者两项呼吸睡眠监测指标,睡眠暂停低通气指数(AHI)及最低血氧饱和度(LSPO2),同时用酶联免疫吸附测定法(ELISA)测定其血清脂联素、和肽素及铁调素的水平。结果:1.OSAHS患者(病例组)与正常对照组间的性别、年龄及总胆固醇(TC)无统计学差异(P0.05)。OSAHS患者较正常组相比,甘油三酯(TG)、低密度脂蛋白(LDL)、收缩压(SBP)、舒张压(DBP)、血尿酸(UA)、体重指数(BMI)、空腹血糖(FBG)、空腹胰岛素(Fins)、胰岛素抵抗指数(HOMA-IR)、和肽素及铁调素均有不同程度的升高,且均有统计学差异(P0.05),而高密度脂蛋白(HDL)及脂联素较正常组相比,均降低,且均有统计学差异(P0.05)。2.将OSAHS患者睡眠监测指标AHI分别与各指标进行相关性分析后,发现OSAHS患者AHI与Hb A1c、BMI、FBG、Fins及HOMA-IR存在相关性,且呈正相关,相关系数分别为(r=0.49,P=0.01;r=0.33,P=0.02;r=0.45,P=0.01;r=0.38,P=0.02;r=0.62,P=0.01)而与LSPO2呈负相关,相关系数为(r=-0.35,P=0.02),但与TG、HDL、LDL、SBP、DBP及UA均无相关性(r=0.14,P=0.34;r=0.13,P=0.39;r=-0.09,P=0.55;r=0.11,P=0.56;r=-0.31,P=0.07;r=0.28,P=0.07)。3.OSAHS患者各组血清脂联素、和肽素及铁调素进行比较,与轻度和中度OSAHS患者相比,重度OSAHS患者,其血清脂联素水平显著下降,而和肽素及铁调素水平明显升高。4.将OSAHS患者血清脂联素、和肽素及铁调素分别与其血清指标及睡眠监测指标进行相关性分析后,发现血清脂联素与LSPO2呈正相关(r=0.41,P0.01),而与AHI及HOMA-IR呈负相关,相关系数分别为(r=-0.87,P0.01;r=-0.46,P0.01)但与Fins未发现相关性(r=-0.27,P0.05);OSAHS患者血清和肽素及铁调素水平均与AHI呈正相关(r=0.75,P0.01;r=0.0.88,P0.01),而与LSPO2呈负相关(r=-0.63,P0.01;r=-0.30,P0.05)。5.分别绘制血清脂联素、和肽素及铁调素的受试者工作曲线(ROC曲线),以血清脂联素浓度为8.02μg/ml作为诊断OSAHS的阈值时,ROC曲线下面积为0.9±0.04,95%的可信区间为0.83~0.97,灵敏度为73%,特异度为100%;以血清和肽素浓度为8.63pmol/l作为诊断OSAHS的阈值时,ROC曲线下面积为0.97±0.02,95%的可信区间为0.93~1.00,灵敏度为97%,特异度为100%。以血清铁调素浓度为482.32pg/ml为诊断OSAHS的阈值时,ROC曲线下面积为0.97±0.02,95%的可信区间为0.93~1.00,灵敏度为97%,特异度为100%。结论:1.OSAHS患者常伴发高血压、高血糖、高血脂、高尿酸、肥胖及胰岛素抵抗等因素。2.血清脂联素、和肽素及铁调素的异常表达与OSAHS患者病情的严重性相关。脂联素是OSAHS的保护因素。3.血清脂联素、和肽素及铁调素未来有可能成为预测OSAHS患者的生物学标记物。
[Abstract]:Objective: To study the relationship between adiponectin (APN), cop and hep in patients with metabolic syndrome complicated with obstructive sleep apnea hypopnea syndrome (OSAHS), to further clarify the role of adiponectin, peptidin and ferritin in the pathogenesis of OSAHS, and to explore whether they can provide clinical evaluation for OSAHS patients. Methods: A total of 44 patients with OSAHS (30 mild, 5 moderate and 5 severe) were selected randomly from April 2015 to November 2015 and were monitored by polysomnography (PSG) in the Department of Diabetes, Second Hospital of Lanzhou University. Thirty healthy people without snoring were selected as the normal control group in the physical examination center of the hospital. The sleep apnea hypopnea index (AHI) and the lowest oxygen saturation (LSPO2) were monitored in OSAHS patients. The serum adiponectin, peptides and ferritin levels were determined by enzyme-linked immunosorbent assay (ELISA). There was no significant difference in sex, age, and total cholesterol (TC) between the two groups (P 0.05). Compared with the normal group, patients with OSAHS had triglyceride (TG), low density lipoprotein (LDL), systolic blood pressure (SBP), diastolic blood pressure (DBP), serum uric acid (UA), body mass index (BMI), fasting blood glucose (FBG), fasting insulin (Fins), insulin resistance index (HOMA-IR). The levels of HDL and adiponectin in OSAHS patients were significantly lower than those in the normal group (P 0.05). 2. The correlation between AHI and Hb A1c, BMI, FBG, FBG, and Hb A1c in OSAHS patients was analyzed. Fins and HOMA-IR were correlated and positively correlated with Fins and HOMA-IR (r = 0.49, P = 0.01; r = 0.49, P = 0.01; r = 0.33, P = 0.02; r = 0.45, P = 0.01; r = 0.45, P = 0.01; r = 0.01; r = 0.38, P = 0.38, P = 0.02; r = 0.62, P = 0.62, P = 0.01) and LSPO2 was necorrelwith LSPO2, correlation coefficient was (r =-0.35, P = 0.02), but not correlwith TG, HDL, LDL, LDL, SBL, DBP, DBP, DBP and UA (r = 0.14, P = 0.14, P = 39; r = - 0.09, P = 0.55; r = 0.11, P = 0.56; r = - Serum adiponectin, peptidin and ferritin levels in patients with OSAHS were significantly lower than those in patients with mild and moderate OSAHS, while serum adiponectin, peptidin and ferritin levels in patients with OSAHS were significantly higher than those in patients with mild and moderate OSAHS. Serum adiponectin was positively correlated with LSPO2 (r = 0.41, P 0.01), but negatively correlated with AHI and HOMA-IR (r = - 0.87, P 0.01; r = - 0.46, P 0.01), respectively, but not with Fins (r = - 0.27, P 0.05); serum adiponectin and ferritin levels in OSAHS patients were positively correlated with AHI. Guan (r = 0.75, P 0.01; r = 0.0.88, P 0.01), but negatively correlated with LSPO2 (r = - 0.63, P 0.01; r = - 0.30, P 0.05). 5. The subjects'working curves of adiponectin, peptidin and ferritin (ROC curves) were drawn respectively. When the serum adiponectin concentration was 8.02 ug/ml as the threshold value of OSAHS, the area under the ROC curve was 0.9 + 0.04, 95% confidence interval was 0.83 ~ 0.83%. When the serum and peptide concentrations were 8.63 pmol/l, the area under the ROC curve was 0.97+0.02, the 95% confidence interval was 0.93~1.00, the sensitivity was 97% and the specificity was 100%. When the serum ferritin concentration was 482.32 pg/ml, the area under the ROC curve was 0.97+0.02, 95% for the diagnosis of OSAHS. Conclusion: 1. OSAHS patients often have hypertension, hyperglycemia, hyperlipidemia, hyperuricemia, obesity and insulin resistance. 2. Abnormal expression of serum adiponectin, peptidin and ferritin is related to the severity of OSAHS. Adiponectin is the protective factor of OSAHS. 3. Serum adiponectin is the protective factor of OSAHS. Adiponectin, peptide and hepcidin may become biomarkers for predicting OSAHS patients in the future.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R589;R766

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