Division of Hepatology, Department of Internal Medicine, Mayo Clinic, Phoenix, Arizona, USA.
Ann Hepatol. 2012 Mar-Apr;11(2):228-31.
Obstructive sleep apnea (OSA) and non-alcoholic fatty liver disease (NAFLD) are both strongly associated with obesity. Whether OSA is an independent risk factor for liver injury is uncertain.
To assess the hypothesis that OSA is associated with liver injury independent of obesity.
We reviewed the histories of 73 consecutive patients referred to a hospital-based sleep lab because of suspected OSA. OSA was determined to be present if the apnea-hypopnea index was > 10. Obesity was defined as a BMI ≥ 30 kg/m 2 . Patients were included for analysis if they had aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels obtained within 60 days of sleep study. Patients with evidence of viral hepatitis, autoimmune-, metabolic- or established alcoholic-liver disease were excluded. Patients who reported alcohol intake equivalent to a dose ≥ 20 g/day were also excluded. 53 of 73 patients met study criteria. Patients were subdivided for analysis into groups meeting or not meeting OSA and obesity criteria, and having or not having elevated aminotransferase levels.
35/53 patients (66%) had OSA. 31/53 (58%) patients were obese. 15 (28%) and 12 (23%) patients had elevated AST and ALT, respectively. Mean age, gender distribution, mean BMI and percentage with either diabetes or hyperlipidemia were not significantly different in those with or without OSA. Elevated ALT was found in 11/35 (31%) patients with OSA, compared to 1/18 patients without OSA (p = 0.041). Frequency of elevated AST [obese 11/31 (35%); non-obese 4/22 (18%)] or ALT [obese 10/31 (32%); non-obese 2/22 (9%)] was not significantly different in the obese and non-obese cohorts.
OSA may be a risk factor for liver injury independent of obesity. The prevalence and nature of liver disease in the setting of OSA should be determined with larger, prospective studies. The impact of OSA treatment, if any, on liver injury should be similarly evaluated.
阻塞性睡眠呼吸暂停（OSA）和非酒精性脂肪性肝病（NAFLD）均与肥胖密切相关。OSA 是否是肝损伤的独立危险因素尚不确定。
评估 OSA 是否与肥胖无关的肝损伤相关的假设。
我们回顾了因疑似 OSA 而被转至医院睡眠实验室的 73 例连续患者的病史。如果呼吸暂停-低通气指数（apnea-hypopnea index，AHI）> 10，则认为存在 OSA。肥胖定义为 BMI≥30 kg/m2。如果在睡眠研究的 60 天内获得了天冬氨酸氨基转移酶（aspartate aminotransferase，AST）和丙氨酸氨基转移酶（alanine aminotransferase，ALT）水平，则将患者纳入分析。排除有病毒性肝炎、自身免疫性、代谢性或已确诊的酒精性肝病证据的患者。排除报告饮酒量相当于 20 g/天以上的患者。73 例患者中有 53 例符合研究标准。为分析起见，将患者分为符合或不符合 OSA 和肥胖标准的两组，并分为具有或不具有升高的氨基转移酶水平的两组。
53 例患者中有 35 例（66%）患有 OSA。53 例患者中有 31 例（58%）肥胖。分别有 15 例（28%）和 12 例（23%）患者 AST 和 ALT 升高。具有或不具有 OSA 的患者之间，年龄、性别分布、平均 BMI 和糖尿病或高脂血症的比例无显著差异。在患有 OSA 的 35 例患者中，有 11 例（31%）ALT 升高，而在没有 OSA 的 18 例患者中，有 1 例（5%）（p=0.041）。在肥胖组和非肥胖组中，AST[肥胖组 11/31（35%）；非肥胖组 4/22（18%）]或 ALT[肥胖组 10/31（32%）；非肥胖组 2/22（9%）]升高的频率无显著差异。
OSA 可能是肥胖以外的肝损伤的危险因素。应该通过更大的前瞻性研究确定 OSA 患者中肝脏疾病的患病率和性质。同样应评估 OSA 治疗对肝损伤的影响（如果有的话）。
