2型糖尿病并OSAHS患者颈围、颈长、体脂成分测定相关性分析
发布时间：2018-08-20 10:51
【摘要】：目的阻塞性睡眠呼吸暂停低通气综合征(Obstructive Sleep Apnea Hypopnea Syndrome,OSAHS)是一种严重危害人们身体健康并降低生活质量甚至威胁生命的临床常见疾病。常伴有胰岛素抵抗、交感神经兴奋、氧化应激、慢性炎症反应,是肥胖、2型糖尿病、代谢综合征常见合并症。有研究显示,2型糖尿病患者中,OSAHS的患病率逐年增加,纠正夜间通气可以改善胰岛素抵抗,降低交感神经兴奋,降低血压。目前,多导睡眠监测是诊断OSAHS的金标准,但其价格昂贵,依从性差。所以对于选取常用测量指标筛选和诊断阻塞性睡眠呼吸暂停综合征具有简单、易行的临床指导意义。本文通过测量2型糖尿病伴打鼾患者颈围、颈长、体脂成分,分析其与呼吸暂停低通气指数(Apnea Hyponea Index,AHI)的相关性。方法选取2015年1月至2016年9月于我院内分泌科住院2型糖尿病患者并夜间睡眠打鼾者136例,对其测量颈围、颈长、体脂成分等指标,以及利用多导睡眠图监测(PSG)测量AHI、氧减指数(ODI)、最低血氧饱和度等指标,依据AHI分为非OSAHS、轻度、中度、重度四组(5、5~15、15~30、≥30次/h),分析组间BMI、腰围、臀围、颈围、颈长、体脂成分指标与AHI的相关性,同时对各指标进行Logistic回归分析。结果2型糖尿病伴OSAHS组与2型糖尿病非OSAHS组之间比较,空腹血糖、血压、血脂、血清尿酸组间无统计学差异(P0.05);颈围具有统计学差异(t=-2.185,P=0.031),经身高校正的颈围仍具有统计学意义(t=-2.705,P0.05);依据AHI分4组后,组间比较BMI、颈围、颈长与OSAHS的严重程度呈正相关(P0.05)。在男性,内脏脂肪指数、身体脂肪率、皮下脂肪指数与OSAHS的严重程度有关系,且重度OSAHS组在以上指标较轻、中度OSAHS组大,在男性,组间比较有统计学差异(P0.05),而在女性,组间比较无统计学差异(P0.05)。采用受试者工作特征(receiver operating characteristic curve,ROC)曲线判断,预测OSAHS颈围的最佳切点为41.2cm,敏感性和特异性分别为56.9%和70%,曲线下面积为0.646(95%CI 0.564~0.727);预测OSAHS的颈长的最佳切点为6.5cm,敏感性和特异性分别为62.5%和70%,曲线下面积为0.606(95%CI 0.529~0.683)。各指标进行Logistic回归分析显示,颈围、颈长是OSAHS患病风险独立正相关(P0.05,OR=3.905)、(P0.05,OR=4.841)。结论颈围、颈长是2型糖尿病患者合并OSAHS的独立危险因素。区分性别后发现,在男性,颈长是其独立危险因素,颈长越长越易出现OSAHS并且OSAHS程度越严重;而在女性,颈围是其独立危险因素,颈围越粗越易出现OSAHS且OSAHS程度越严重。本文通过分析得出颈围、颈长筛选OSAHS的最佳切点,这为临床工作中筛选OSAHS提供了辅助手段。意义本文通过分析2型糖尿病合并阻塞性睡眠呼吸暂停综合征患者颈围、颈长及体脂成分与呼吸低通气指数(AHI)的相关性,发现颈围、颈长与睡眠呼吸暂停有关系。同时,分析得出颈围、颈长筛选OSAHS的最佳切点,这为临床工作中筛选OSAHS提供了辅助手段。
[Abstract]:Objective obstructive sleep apnea hypopnea syndrome (Obstructive Sleep Apnea Hypopnea Syndrome OSAHS) is a common clinical disease which seriously endangers people's health and reduces the quality of life and even threatens life. Often accompanied by insulin resistance, sympathetic excitement, oxidative stress, chronic inflammatory response, obesity type 2 diabetes mellitus, metabolic syndrome is common complications. Some studies have shown that the prevalence of OSAHS in patients with type 2 diabetes is increasing year by year. Correcting nocturnal ventilation can improve insulin resistance, reduce sympathetic excitement and lower blood pressure. At present, polysomnography is the gold standard for diagnosis of OSAHS, but its price is high and compliance is poor. So it is simple and easy to select and diagnose obstructive sleep apnea syndrome (OSAS). By measuring the neck circumference, neck length and body fat composition of type 2 diabetes mellitus patients with snoring, the relationship between the neck circumference, neck length and apnea hypopnea index (Apnea Hyponea Indexa AHI) was analyzed. Methods from January 2015 to September 2016, 136 patients with type 2 diabetes mellitus and nocturnal sleep snoring were selected and their neck circumference, neck length and body fat composition were measured. The (PSG) was measured by polysomnography, the oxygen reductive index (ODI),) and the lowest oxygen saturation were measured. According to AHI, the patients were divided into four groups: non-OSAS, mild, moderate and severe (5 / 5, 1515, 1530, 鈮，
本文编号：2193324
[Abstract]:Objective obstructive sleep apnea hypopnea syndrome (Obstructive Sleep Apnea Hypopnea Syndrome OSAHS) is a common clinical disease which seriously endangers people's health and reduces the quality of life and even threatens life. Often accompanied by insulin resistance, sympathetic excitement, oxidative stress, chronic inflammatory response, obesity type 2 diabetes mellitus, metabolic syndrome is common complications. Some studies have shown that the prevalence of OSAHS in patients with type 2 diabetes is increasing year by year. Correcting nocturnal ventilation can improve insulin resistance, reduce sympathetic excitement and lower blood pressure. At present, polysomnography is the gold standard for diagnosis of OSAHS, but its price is high and compliance is poor. So it is simple and easy to select and diagnose obstructive sleep apnea syndrome (OSAS). By measuring the neck circumference, neck length and body fat composition of type 2 diabetes mellitus patients with snoring, the relationship between the neck circumference, neck length and apnea hypopnea index (Apnea Hyponea Indexa AHI) was analyzed. Methods from January 2015 to September 2016, 136 patients with type 2 diabetes mellitus and nocturnal sleep snoring were selected and their neck circumference, neck length and body fat composition were measured. The (PSG) was measured by polysomnography, the oxygen reductive index (ODI),) and the lowest oxygen saturation were measured. According to AHI, the patients were divided into four groups: non-OSAS, mild, moderate and severe (5 / 5, 1515, 1530, 鈮，
本文编号：2193324
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