2型糖尿病合并阻塞性睡眠呼吸暂停综合征的临床特点分析

发布时间：2018-06-21 09:22

本文选题：型糖尿病 + 阻塞性睡眠呼吸暂停综合征　；参考：《四川大学学报(医学版)》2017年03期

【摘要】：目的比较合并不同程度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea syndrome,OSAS)的2型糖尿病(T2DM)患者的临床特点和慢性并发症的差异。方法收集170例T2DM合并OSAS患者的人口学数据、生化指标和慢性并发症情况等。根据呼吸暂停低通气指数(apnea hypopnea index,AHI),将OSAS患者分为轻度、中度、重度3组,对3组患者的人口学数据、生化指标和慢性并发症发生率进行比较。通过多因素logistic回归分析慢性并发症与OSAS相关关系。结果与轻、中度OSAS相比,T2MD合并重度OSAS患者有更大的腰围(P=0.045)和倾向于有更高的体质量指数(BMI)(P=0.069)。随着OSAS程度的加重,糖尿病周围神经病变的发生率逐渐升高(轻vs.中vs.重,40.0%vs.42.9%vs.58.8%,P=0.07),糖尿病视网膜病变发生率逐渐升高(12.7%vs.25.7%vs.30.0%,P=0.061),但差异均无统计学意义。3组患者之间大血管并发症发生率相似(P均0.05)。Logistic回归分析显示:调整最低血氧饱和度、性别、年龄、糖尿病病程、糖尿病家族史、BMI和糖化血红蛋白等多种因素后,周围神经病变、慢性肾脏疾病与AHI呈独立相关关系(比值比=1.024,95%可信区间1.002~1.046,P=0.033;比值比=1.026,95%可信区间1.004~1.049,P=0.022)。其它微血管并发症和大血管并发症未显示与AHI存在相关关系。结论重度OSAS或可加重T2DM患者糖尿病周围神经病变和视网膜病变的潜在风险,但尚需更多证据支持。
[Abstract]:Objective to compare the clinical characteristics and chronic complications of type 2 diabetes mellitus (T2DM) with obstructive sleep apnea syndrome (OSAS). Methods demographic data, biochemical indexes and chronic complications of 170 patients with T2DM complicated with OSAS were collected. According to apnea hypopnea index, the patients were divided into three groups: mild, moderate and severe. The demographic data, biochemical indexes and the incidence of chronic complications were compared among the three groups. By multivariate logistic regression analysis, chronic complications were correlated with OSAS. Results compared with mild and moderate OSAS patients with T2MD with severe OSAS had greater waist circumference (P0.045) and tended to have higher body mass index (BMI). With the severity of OSAS, the incidence of diabetic peripheral neuropathy gradually increased (mild vs. VS. The incidence of diabetic retinopathy increased by 12.7vs.25.7vs.30.061g, but there was no significant difference in the incidence of macrovascular complications between the three groups. Logistic regression analysis showed that the minimum oxygen saturation, sex, age, course of diabetes, and the course of diabetes were adjusted. After diabetes family history, BMI, glycosylated hemoglobin and other factors, there was an independent correlation between peripheral neuropathy, chronic renal disease and AHI (the ratio was 1.024% 95% confidence interval 1.002 ~ 1.046% P 0.033; ratio 1.026 95% confidence interval 1.004 ~ 1.049% P 0.022 22). Other microvascular complications and macrovascular complications were not associated with AHI. Conclusion severe OSAS may aggravate the potential risk of diabetic peripheral neuropathy and retinopathy in T2DM patients, but more evidence is needed.
【作者单位】：四川大学华西医院内分泌代谢科糖尿病足诊治中心;成都市第一人民医院内分泌科;四川大学华西临床医学院;
【基金】：国家自然科学基金面上项目(No.81471043) 四川省科技厅科技支撑计划项目(No.2015SZ0228-4)资助
【分类号】：R587.1;R766

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