间歇性低氧与 2 型糖尿病和阻塞性睡眠呼吸暂停低通气综合征中的肠道微生物失调有关。

BACKGROUND: Obstructive sleep apnea (OSA)-hypopnea syndrome (OSAHS) has been recognized as a comorbidity of type 2 diabetes mellitus (T2DM); more than half of T2DM patients suffer from OSAHS. Intermittent hypoxia (IH) plays an important role in metabolic diseases, such as obesity and OSAHS, through various mechanisms, including altering the gut microecological composition and function. Therefore, it is important to study the role of gut microbiota in T2DM patients with OSAHS, which has a high incidence and is prone to several complications. AIM: To assess whether IH is involved in altering the fecal microbiome in T2DM patients with OSAHS. METHODS: Seventy-eight participants were enrolled from Henan Province People's Hospital and divided into healthy control (HC, = 26), T2DM ( = 25), and T2DM + OSA ( = 27) groups based on their conditions. The fecal bacterial DNA of the research participants was extracted and subjected to 16S ribosomal RNA sequencing. The clinical indices, such as insulin resistance index, homocysteine (HCY) concentration, and the concentrations of inflammatory factors in the peripheral blood, were assessed and recorded. RESULTS: Group T2DM + OSA had the highest apnea-hypopnea index (AHI) (2.3 3.7 13.7), oxygen desaturation index (0.65 2.2 9.1), HCY concentration (9.6 μmol/L 10.3 μmol/L 13.81 μmol/L) and C-reactive protein (CRP) concentrations (0.3 mg/L 1.43 mg/L 2.11 mg/L), and lowest mean oxygen saturation (97.05% 96.6% 94.7%) among the three groups. Twelve and fifteen key differences in amplicon sequence variants were identified when comparing group T2DM + OSA with groups T2DM and HC, respectively. We found progressively decreased levels of , and and an increase in the level of which strongly correlated with the HCY, CRP, fasting plasma glucose, and hemoglobin A1c concentrations, AHI, mean oxygen saturation, and insulin resistance index in group T2DM + OSA ( < 0.05). CONCLUSION: For T2DM patients with OSAHS, IH may be involved in selective alterations of the gut microbiota, which may affect the pathophysiological development of T2DM and DM-related complications.

背景：阻塞性睡眠呼吸暂停低通气综合征（OSAHS）已被认为是 2 型糖尿病（T2DM）的合并症之一；超过一半的 T2DM 患者患有 OSAHS。间歇性低氧（IH）通过改变肠道微生物群落组成和功能等多种机制，在肥胖和 OSAHS 等代谢性疾病中发挥重要作用。因此，研究 OSAHS 伴 2 型糖尿病患者肠道微生物群的作用非常重要，因为 OSAHS 发病率高，且易发生多种并发症。

目的：评估间歇性低氧是否参与改变 OSAHS 伴 2 型糖尿病患者的粪便微生物群。

方法：本研究共招募了 78 名来自河南省人民医院的参与者，根据他们的病情分为健康对照组（HC，n=26）、T2DM 组（n=25）和 T2DM+OSA 组（n=27）。提取研究参与者的粪便细菌 DNA，并进行 16S 核糖体 RNA 测序。评估并记录临床指标，如胰岛素抵抗指数、同型半胱氨酸（HCY）浓度和外周血中炎症因子的浓度。

结果：T2DM+OSA 组的呼吸暂停低通气指数（AHI）最高（2.3 3.7 13.7），氧减指数（0.65 2.2 9.1）、HCY 浓度（9.6 μmol/L 10.3 μmol/L 13.81 μmol/L）和 C 反应蛋白（CRP）浓度（0.3 mg/L 1.43 mg/L 2.11 mg/L）最高，三组中最低的平均氧饱和度为 97.05%、96.6%和 94.7%。与 T2DM 组和 HC 组相比，T2DM+OSA 组分别有 12 个和 15 个扩增子序列变异的关键差异。我们发现，随着 T2DM+OSA 组 HCY、CRP、空腹血糖和糖化血红蛋白浓度、AHI、平均氧饱和度和胰岛素抵抗指数的增加，、、和水平逐渐降低，水平升高（<0.05）。

结论：对于 OSAHS 伴 2 型糖尿病患者，IH 可能参与了肠道微生物群的选择性改变，这可能影响 2 型糖尿病及其相关并发症的病理生理发展。