阻塞性呼吸暂停综合征对冠心病患者糖代谢及氧化低密度脂蛋白胆固醇水平的影响

发布时间：2018-03-22 23:23

本文选题：冠心病　切入点：阻塞性睡眠呼吸暂停综合征　出处：《医学综述》2016年08期 　论文类型：期刊论文

【摘要】：目的探讨阻塞性睡眠呼吸暂停综合征(OSAS)对冠心病患者糖代谢及氧化低密度脂蛋白胆固醇(ox-LDL)的影响。方法选择2009年9月至2013年9月在成都市第六人民医院呼吸科和心内科住院、冠状动脉造影确诊冠心病的患者410例,根据呼吸暂停低通气指数(AHI)分为冠心病组(90例)和冠心病合并OSAS组(320例)。根据AHI严重程度将冠心病合并OSAS患者分为3个亚组:轻度86例、中度108例和重度126例。对两组患者进行口服糖耐量胰岛素释放试验、糖化血红蛋白(HbA_(1c))及ox-LDL-C水平检测。结果冠心病合并OSAS中、重度组空腹血糖、胰岛素抵抗指数(HOMA-IR)、糖化血红蛋白(HbA_(1c))、ox-LDL-C分别为(6.7±1.2)mmol/L、3.3±0.4、(5.8±0.6)%、(102±23)mmol/L和(7.9±2.1)mmol/L、3.9±0.5、(6.6±0.7)%、(137±25)mmol/L,均高于冠心病组[(5.5±0.6)mmol/L、2.6±0.3、(4.6±0.6)%、(85±21)mmol/L]和轻度组[(5.6±0.6)mmol/L、2.7±0.3、(4.7±0.6)%、(85±22)mmol/L],重度组高于中度组,差异均有统计学意义(P0.01)。AHI与FPG、HOMA-IR、HbA_(1c)、ox-LDL-C呈正相关(r=0.76,P=0.00;r=0.79,P=0.00;r=0.78,P=0.00;r=0.79,P=0.00)。结论 OSAS增加了冠心病患者糖代谢异常的风险,其机制与低氧血症引起的胰岛素抵抗及血浆ox-LDL升高相关。
[Abstract]:Objective to investigate the effects of obstructive sleep apnea syndrome (OSAS) on glucose metabolism and oxidized low density lipoprotein cholesterol (ox-LDL) in patients with coronary heart disease (CHD). According to the apnea hypopnea index (AHI), 410 patients with coronary heart disease were divided into coronary heart disease group (90 cases) and coronary heart disease with OSAS group (320 cases). According to the severity of AHI, patients with coronary heart disease complicated with OSAS were divided into three subgroups: mild 86 cases. Two groups of patients were treated with oral glucose tolerance insulin release test (IGT), HbA1cU) and ox-LDL-C levels. Results fasting blood glucose was measured in the moderate and severe OSAS patients with coronary heart disease (CHD) and severe coronary heart disease (OSAS). The insulin resistance index (HOMA-IRL), HbA1C were 6.7 卤1.2 mmol / L 3.3 卤0.4 mmol / L 3.3 卤0.4 mmol / L = 102 卤23)mmol/L and 7.9 卤2.1 mmol / L = 3.9 卤0.56.6 卤0.56.6 卤0.57 mmol / L respectively, which were higher than those in the coronary heart disease group (5.5 卤0.6 mmol / L, 2.6 卤0.34.6 卤0.685 卤21)mmol/L) and in the mild group [5.6 卤0.6 mmol / L, 2.7 卤0.34.7 卤0.685 卤85 22)mmol/L], respectively, and were significantly higher in the severe group than in the coronary heart disease group (5.5 卤0.6 mmol / L, 2.6 卤0.34.6 卤0.685 卤21)mmol/L), and in the mild group [5.6 卤0.6 mmol / L, 2.7 卤0.34.7 卤0.685 卤85 22)mmol/L]. There was a positive correlation between OSAS and HOMA-IRB / HbA-1 / LDL-C in patients with coronary heart disease. Conclusion OSAS can increase the risk of abnormal glucose metabolism in patients with coronary heart disease, and its mechanism is related to insulin resistance induced by hypoxemia and the increase of plasma ox-LDL.
【作者单位】：成都市第六人民医院呼吸内科;成都医学院第一附属医院心内科;
【分类号】：R766;R541.4

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