[低度慢性炎症与2型糖尿病患者的阻塞性睡眠呼吸暂停综合征相关]

[Lower grade chronic inflammation is associated with obstructive sleep apnea syndrome in type 2 diabetes mellitus].

作者信息

Zhu Hongxia, Wang Zhenshan, Xue Xin, Zhang Ping, Yang Chunmei, Su Benli

机构信息

Department of Endocrinology and Metabolism, the Second Hospital of Dalian Medical University, Dalian 116023, China.

Department of Endocrinology and Metabolism, the Second Hospital of Dalian Medical University, Dalian 116023, China. Email:

出版信息

Zhonghua Jie He He Hu Xi Za Zhi. 2014 Jun;37(6):411-5.

PMID:25200039

Abstract

OBJECTIVE

To investigate whether the existence of obstructive sleep apnea syndrome (OSAS) in patients with type 2 diabetes (T2DM) is associated with low grade chronic inflammation.

METHODS

Fifty-four patients hospitalized for poor glycemic control from 12/2008 to 12/2009 were divided into 2 groups, OSAS group (T2DM with OSAS, 27 cases) and NOSAS group (T2DM without OSAS, 27 cases). The control group consisted of 26 people from a health check-up program without diabetes and OSAS. Biochemical indexes were analyzed in central laboratory of the hospital. Serum tumor necrosis factor-α(TNF-α), lipopolysaccharides (LPS), monocyte chemoattractant protein-1 (MCP), and plasminogen activator inhibitor-1 (PAI) levels were determined with commercial ELISA kits. Apnea hypopnea index (AHI), the lowest pulse oxygen saturation (LSpO₂) at night were measured with a portable home sleep monitor.

RESULTS

Homeostasis model assessment insulin resistance index (HOMA-IR), AHI in OSAS group were higher than those in NOSAS group and control group [for HOMA-IR, 2.7 ± 1.5 vs 1.7 ± 0.9 vs 1.2 ± 0.7, and for AHI, (17.0 ± 13.0) vs (3.4 ± 1.3) vs (3.2 ± 1.2) per hour], and LSpO₂ was lower than that in NOSAS group and control group [(78 ± 11)% vs (87 ± 4)% vs (89 ± 6)%]. Compared with normal control, levels of TNF-α [(0.73 ± 0.19) vs (1.97 ± 0.13) vs (1.09 ± 0.29) ng/ml], LPS [(50 ± 11) vs (303 ± 70) vs (171 ± 49) pg/ml], MCP [(302 ± 41) vs (514 ± 122) vs (473 ± 134) pg/ml] and PAI [(0.89 ± 0.25) vs (2.27 ± 0.85) vs (1.59 ± 0.13) ng/ml] in patients with OSAS and with NOSAS group increased significantly. Pearson univariate correlation analysis revealed that TNF-α and PAI were both positively associated with HOMA-IR, FBG and AHI, and negatively with LSpO₂, LPS, MCP were both associated positively with FBG and AHI, and negatively with LSpO₂. Multiple linear regression stepwise analysis found that TNF-α and LPS were independently associated with AHI and FBG, MCP with LSpO₂, PAI with both AHI and HOMA-IR.

CONCLUSIONS

Patients with diabetes and OSAS show raised level of chronic inflammatory activity.

摘要

目的

探讨2型糖尿病（T2DM）患者中阻塞性睡眠呼吸暂停综合征（OSAS）的存在是否与低度慢性炎症相关。

方法

将2008年12月至2009年12月因血糖控制不佳住院的54例患者分为2组，OSAS组（T2DM合并OSAS，27例）和NOSAS组（T2DM不合并OSAS，27例）。对照组由26名来自健康体检项目且无糖尿病和OSAS的人员组成。在医院中心实验室分析生化指标。用商用ELISA试剂盒测定血清肿瘤坏死因子-α（TNF-α）、脂多糖（LPS）、单核细胞趋化蛋白-1（MCP）和纤溶酶原激活物抑制剂-1（PAI）水平。用便携式家庭睡眠监测仪测量呼吸暂停低通气指数（AHI）、夜间最低脉搏血氧饱和度（LSpO₂）。

结果

OSAS组的稳态模型评估胰岛素抵抗指数（HOMA-IR）、AHI高于NOSAS组和对照组[HOMA-IR分别为2.7±1.5、1.7±0.9、1.2±0.7，AHI分别为（17.0±13.0）、（3.4±1.3）、（3.2±1.2）次/小时]，LSpO₂低于NOSAS组和对照组[分别为（78±11）%、（87±4）%、（89±6）%]。与正常对照组相比，OSAS组和NOSAS组患者的TNF-α[（0.73±0.19）、（1.97±0.13）、（1.09±0.29）ng/ml]、LPS[（50±11）、（303±70）、（171±49）pg/ml]、MCP[（302±41）、（514±122）、（473±134）pg/ml]和PAI[（0.89±0.25）、（2.27±0.85）、（1.59±0.13）ng/ml]水平显著升高。Pearson单因素相关性分析显示，TNF-α和PAI均与HOMA-IR、空腹血糖（FBG）和AHI呈正相关，与LSpO₂呈负相关，LPS、MCP均与FBG和AHI呈正相关，与LSpO₂呈负相关。多元线性回归逐步分析发现，TNF-α和LPS与AHI和FBG独立相关，MCP与LSpO₂相关，PAI与AHI和HOMA-IR均相关。