OSAS患者血清同型半胱氨酸水平、胰岛素抵抗及其相互关系

发布时间：2018-05-13 21:00

本文选题：阻塞性睡眠呼吸暂停综合征 + 高同型半胱氨酸血症　；参考：《汕头大学》2010年硕士论文

【摘要】：引言阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)是一种常见的睡眠呼吸障碍。近年研究表明,OSAS与脑梗死及脑梗死的多种危险因素如高血压、糖尿病、心房纤颤等密切相关。已发现OSAS患者体内存在胰岛素抵抗;据研究,胰岛素抵抗可引起高同型半胱氨酸血症(Hyperhomocysteinemia,HHcy),而HHcy是脑梗死的独立危险因素。那么,OSAS是否可能通过胰岛素抵抗影响同型半胱氨酸(Homocysteine,Hcy)的代谢,进而导致脑梗死的发生呢?经检索目前尚无这方面的报道。本研究拟通过观察OSAS患者体内胰岛素抵抗及Hcy水平,分析OSAS、胰岛素抵抗和Hcy之间的关系,进一步探讨OSAS患者HHcy及脑梗死发生的可能机制。材料与方法入选者为于2009年1月~2009年9月在北京大学深圳医院干部病房行睡眠呼吸监测的住院或门诊病人。对入选者用Epworth嗜睡量表(Epworth sleepiness scale,ESS)进行嗜睡评分。按照便携式睡眠呼吸监测仪的监测结果,将入选者分为OSAS组(n=22)与对照组(n=20)。在多导睡眠监测完成的当天检测其空腹血清Hcy、血糖、血清胰岛素及血脂,计算出体内稳态模式评估下的胰岛素抵抗指数(Homeostasis model assessment of insulin resistance,HOMA-IR),HOMA-IR=空腹胰岛素(μIU/ml))×空腹血糖(mmol/L)/22.5。比较OSAS组同对照组血清Hcy及HOMA-IR水平,探讨Hcy与呼吸暂停低通气指数(apnea hypopnea index,AHI)、HOMA-IR与AHI、Hcy与HOMA-IR的关系。实验结果OSAS组的血清Hcy、HOMA-IR较对照组高[(18.043±6.967,11.835±4.156)μmol/L,P0.05;(4.510±2.877,2.755±1.124),P0.05]。OSAS患者中,Hcy、HOMA-IR与AHI呈正性相关[ (r=0.779,P0.01),(r=0.845,P0.01)],经偏相关分析校正体重指数(Bodymass index,BMI)及年龄的影响后,Hcy、HOMA-IR与AHI仍呈正相关([r'=0.525,P'0.05),(r'=0.725,P'0.01)];在OSAS组,Hcy与HOMA-IR呈正相关(r=0.815,P0.01),经偏相关分析校正BMI及年龄后,Hcy与HOMA-IR仍呈明显的正相关(r'=0.715,P'0.01)。结论OSAS组Hcy、HOMA-IR水平较对照组高(P0.05)。Hcy、HOMA-IR均与OSAS的严重程度呈正相关(P均0.01),Hcy水平与HOMA-IR呈正相关(P0.01)。OSAS可能通过引起胰岛素抵抗而影响Hcy的代谢,引起高同型半胱氨酸血症,导致脑梗死的发生。
[Abstract]:Obstructive sleep apnea syndrome (OSAS) is a common disorder of sleep apnea. In recent years, studies have shown that OSAS is closely related to a variety of risk factors for cerebral infarction and cerebral infarction such as hypertension, diabetes, and atrial fibrillation. The presence of insulin resistance in OSAS patients has been found; according to the study, the pancreas is studied. Isle resistance can cause hyperhomocysteinemia (Hyperhomocysteinemia, HHcy), and HHcy is an independent risk factor for cerebral infarction. Then, is OSAS possible to affect the metabolism of homocysteine (Homocysteine, Hcy) by insulin resistance and lead to the occurrence of cerebral infarction? This study has not been reported. By observing the insulin resistance and the level of Hcy in OSAS patients, the relationship between OSAS, insulin resistance and Hcy was analyzed, and the possible mechanism of HHcy and cerebral infarction in OSAS patients was further explored.
Materials and methods were hospitalized or outpatient patients in the Shenzhen hospital cadre ward of Shenzhen Hospital of Peking University in September January 2009. The drowsiness scores were measured by the Epworth sleepiness scale (ESS). The participants were divided into OSAS group according to the monitoring results of the portable sleep monitor. N=22) and the control group (n=20). On the day of completion of polysomnography, the fasting serum Hcy, blood glucose, serum insulin and blood lipid were measured, and the insulin resistance index (Homeostasis model assessment of insulin resistance, HOMA-IR), HOMA-IR= fasting insulin (IU/ml)) by the homeostasis model of the body was calculated. The serum levels of Hcy and HOMA-IR in the OSAS group were compared with those in the control group, and the relationship between Hcy and apnea hypopnea index (apnea hypopnea index, AHI), HOMA-IR and AHI, Hcy and HOMA-IR were compared.
The serum Hcy and HOMA-IR in OSAS group were higher than those of the control group [(18.043 + 6.967,11.835 + 4.156) mu mol/L, P0.05; (4.510 + 2.877,2.755 + 1.124). In P0.05].OSAS patients, Hcy, HOMA-IR and AHI were positively related [(r=0.779,]]). A-IR is still positively correlated with AHI ([r'=0.525, P'0.05), (r'=0.725, P'0.01)); in OSAS group, Hcy and HOMA-IR are positively correlated (r=0.815, P0.01). After correction of BMI and age by partial correlation analysis, there is still a significant positive correlation.
Conclusion the level of Hcy and HOMA-IR in OSAS group is higher than that of the control group (P0.05).Hcy, HOMA-IR is positively correlated with the severity of OSAS (P 0.01), Hcy level is positively correlated with HOMA-IR (P0.01).OSAS may affect metabolism by causing insulin resistance, causing hyperhomocysteinemia, causing cerebral infarction.

【学位授予单位】：汕头大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R766

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