高血压合并阻塞性睡眠呼吸暂停综合征患者的糖代谢紊乱及胰岛素抵抗

发布时间：2018-02-23 02:33

本文关键词： 原发性高血压阻塞性睡眠呼吸暂停综合征糖代谢紊乱胰岛素抵抗　出处：《中华高血压杂志》2014年04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)对原发性高血压人群糖代谢紊乱和胰岛素抵抗的影响。方法原发性高血压住院患者703例纳入该研究,所有患者均行夜间多导睡眠监测及口服糖耐量和胰岛素释放试验。根据呼吸暂停低通气指数(AHI),研究对象分为原发性高血压组和高血压合并OSAS组(进一步分为轻、中和重度3个亚组)。采用方差分析和多元线性回归的方法分析胰岛素抵抗指数与OSAS的关系;采用卡方检验和Logistic回归分析糖代谢紊乱与OSAS的关系。结果 2型糖尿病的检出率在4组之间比较,差异有统计学意义(P=0.001);重度OSAS组胰岛素抵抗指数(HOMA-IR)高于原发性高血压组和轻度OSAS组,重度OSAS组Matsuda指数低于其他各组,葡萄糖处置指数(DIo)低于原发性高血压组(均P0.05)。Logistic回归分析显示,校正年龄、性别、吸烟和饮酒、肥胖、高血压分级、脂质代谢紊乱等因素后,中、重度OSAS增加了高血压患者发生糖代谢紊乱的风险(P0.05);多重线性回归分析结果示,校正上述混杂因素后,Matsuda指数与AHI(β=-0.116,P=0.01)和氧减饱和度指数(ODI4)(β=-0.146,P=0.003)呈负相关;HOMA-IR与AHI(β=0.097,P=0.034)及ODI4(β=0.162,P=0.001)呈正相关。结论 OSAS增加了高血压患者发生糖代谢紊乱的风险,是高血压患者胰岛素抵抗及胰岛β细胞功能损害的危险因素。高血压合并OSAS(尤其重度OSAS)患者应该常规筛查糖代谢紊乱。
[Abstract]:Objective to investigate the effects of obstructive sleep apnea syndrome (OSAS) on glucose metabolism disorder and insulin resistance in patients with essential hypertension. Methods 703 patients with essential hypertension were included in the study. All patients underwent nocturnal polysomnography and oral glucose tolerance and insulin release tests. According to apnea hypopnea index (AHI), the subjects were divided into essential hypertension group and hypertension combined with OSAS group. The relationship between insulin resistance index and OSAS was analyzed by ANOVA and multivariate linear regression. Chi-square test and Logistic regression analysis were used to analyze the relationship between glucose metabolism disorder and OSAS. Results the detection rate of type 2 diabetes was compared among the four groups. The insulin resistance index (HOMA-IRR) of severe OSAS group was higher than that of essential hypertension group and mild OSAS group, the Matsuda index of severe OSAS group was lower than that of other groups, and the glucose disposal index was lower than that of essential hypertension group (all P0.05. logistic regression analysis showed that there was no significant difference between the two groups. Adjusted for age, sex, smoking and drinking, obesity, hypertension grading, lipid metabolic disorder, moderate and severe OSAS increased the risk of glucose metabolism disorder in hypertensive patients (P 0.05). After adjusting for the above confounding factors, Matsuda index was negatively correlated with AHII (尾 -0.116) and oxygen desaturation index (尾 -0.146) and ODI0.003. HOMA-IR was positively correlated with high blood pressure (尾 -0.097) and ODI4 (尾 0.162 P0. 001). Conclusion OSAS can increase the risk of glucose metabolism disorder in patients with hypertension. It is a risk factor of insulin resistance and islet 尾 cell dysfunction in patients with hypertension. Patients with hypertension complicated with OSAS (especially severe OSAS) should be routinely screened for impaired glucose metabolism.
【作者单位】：新疆医科大学;新疆维吾尔自治区人民医院高血压诊断治疗研究中心;
【基金】：国家重点基础研究发展计划(973计划)(2012CB517802)
【分类号】：R587.1;R766

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