Li Jie, Zhang Yan-Lin, Chen Rui, Wang Yi, Xiong Kang-Ping, Huang Jun-Ying, Han Fei, Liu Chun-Feng
Department of Neurology and Sleep Center, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004; Institute of Neuroscience, Soochow University, Suzhou, Jiangsu 215123; Beijing Key Laboratory for Parkinson's Disease, Beijing 100053, China.
Chin Med J (Engl). 2015 Nov 20;128(22):2983-7. doi: 10.4103/0366-6999.168943.
Obstructive sleep apnea-hypopnea syndrome (OSAS) is associated with elevated liver enzymes and fatty liver. The purpose of this study was to measure serum liver enzyme levels in patients evaluated by polysomnography (PSG) and the factors associated with liver injury in OSAS patients.
All patients referred to PSG for evaluation of sleep apnea symptoms between June 2011 and November 2014 were included in this study. Demographic data and PSG parameters were recorded. Serum alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transferase levels were systematically measured. OSAS patients were divided into mild, moderate, and severe groups according to the apnea-hypopnea index (AHI) values of 5-14 events/h, 15-29 events/h, and ≥30 events/h.
A total of 540 patients were enrolled in this study; among these patients, 386 were male. Elevated liver enzymes were present in 42.3% of OSAS patients (32.4% in mild/moderate group; 51.0% in severe group) and 28.1% patients without OSAS. Patients with OSAS had higher body mass index (BMI) (P < 0.01). In the bivariate correlation, the liver enzymes level was negatively correlated with age and the lowest arterial oxygen saturation (SaO 2 ), and was positively correlated with BMI, oxygen desaturation index, percent of total time with oxygen saturation level <90% (TS90%), AHI, total cholesterol (TC), and triglyceride (TG). In logistic regression analysis, Age, BMI, TS90%, TC, and TG were included in the regression equation.
Our data suggest that OSAS is a risk factor for elevated liver enzymes. The severity of OSAS is correlated with liver enzyme levels; we hypothesize that hypoxia is one of main causes of liver damage in patients with OSAS.
阻塞性睡眠呼吸暂停低通气综合征（OSAS）与肝酶升高及脂肪肝有关。本研究旨在测量经多导睡眠图（PSG）评估的患者血清肝酶水平以及OSAS患者肝损伤的相关因素。
纳入2011年6月至2014年11月间因睡眠呼吸暂停症状转诊至PSG评估的所有患者。记录人口统计学数据和PSG参数。系统测量血清丙氨酸氨基转移酶、天冬氨酸氨基转移酶和γ-谷氨酰转移酶水平。根据呼吸暂停低通气指数（AHI）值将OSAS患者分为轻度（5 - 14次事件/小时）、中度（15 - 29次事件/小时）和重度（≥30次事件/小时）组。
本研究共纳入540例患者；其中386例为男性。42.3%的OSAS患者肝酶升高（轻度/中度组为32.4%；重度组为51.0%），无OSAS的患者中这一比例为28.1%。OSAS患者的体重指数（BMI）更高（P < 0.01）。在双变量相关性分析中，肝酶水平与年龄和最低动脉血氧饱和度（SaO₂）呈负相关，与BMI、氧饱和度下降指数、血氧饱和度水平<90%的总时间百分比（TS90%）、AHI、总胆固醇（TC）和甘油三酯（TG）呈正相关。在逻辑回归分析中，年龄、BMI、TS90%、TC和TG被纳入回归方程。
我们的数据表明OSAS是肝酶升高的一个危险因素。OSAS的严重程度与肝酶水平相关；我们推测缺氧是OSAS患者肝损伤的主要原因之一。
