摘要
目的分析呼吸睡眠暂停低通气综合征(SAHS)对冠心病患者糖脂代谢及血清胆红素水平的影响,以期进一步揭示SAHS促冠心病发病的机制。方法选择2013年12月至2016年12月于宝鸡市中心医院老年心脑血管科就诊的136例冠心病患者作为研究对象,按照是否并发SAHS,分为合并SAHS组(94例)和非SAHS组(42例),进一步根据SAHS的严重程度,分为重度SAHS组(37例)、中度SAHS组(32例)和轻度SAHS组(25例)。比较入组患者的睡眠呼吸指标、糖脂代谢水平及血清胆红素水平。用SPSS 18.0统计软件进行方差分析,两两比较采用SNK-q检验,应用Pearson法进行相关性分析。结果冠心病合并中度、重度SAHS患者空腹血糖(FPG)、餐后2 h血糖(2 hPG)、胰岛素抵抗指数(HOMAIR)、糖化血红蛋白(HbA_(1C))和氧化低密度脂蛋白胆固醇(ox-LDL-C)均明显高于合并轻度SAHS组和非SAHS组患者,合并重度SAHS患者上述指标水平均明显高于合并中度SAHS患者,差异均有统计学意义(P<0.05),与非SAHS组比较,合并轻度SAHS组患者FPG、2 hPG、HOMA-IR、HbA_(1C)和ox-LDL-C水平差异均无统计学意义(P>0.05)。冠心病合并中度、重度SAHS患者血清中总胆红素(TBIL)、间接胆红素(IBIL)水平均明显低于合并轻度SAHS组和非SAHS组患者,合并重度SAHS组患者的上述指标均明显低于合并中度SAHS组患者,差异均有统计学意义(P<0.05),合并轻度SAHS组患者血清中TBIL、IBIL水平与非SAHS组比较,差异均无统计学意义(P>0.05)。相关性分析结果显示,呼吸暂停低通气指数(AHI)与FPG、2 hPG、HbA_(1C)、HOMA-IR和ox-LDL-C均呈明显的正相关(r值分别为0.976、0.986、0.986、0.987和0.960,P<0.01),夜间最低血氧饱和度(LO2)与FPG、2 hPG、HbA_(1C)、HOMA-IR和ox-LDL-C均呈明显的负相关(r值分别为-0.939、-0.976、-0.957、-0.986和-0.913,P<0.01),而AHI和LO2与TBIL、IBIL无明显的相关关系(P>0.05)。结论 SAHS合并冠心病患者普遍存在糖脂代谢及血清胆红素水平异常,这可能是SAHS促冠心病发病的机制。
Objective To analyze the effects of respiratory apnea hypopnea syndrome （SAHS） on glucolipid metabolism and serum bilirubin level in patients with coronary heart disease and to explore the mechanism of coronary heart disease promoted by SAHS. Methods Patients （ 136 cases） with coronary heart disease from Baoji Central Hospital between December 2013 and December 2016 were divided into merging SAHS group （94 cases） and non-SAHS group （42 cases） according to concurrent SAHS or not. The merging SAHS group was further divided light （25 cases）, medium （32 cases） and severe （37 cases） sub-groups according to disease severity. The sleep apnea index, glucolipid metabolism and serum bilirubin levels were compared between two groups. SPSS 18.0 software was used for analysis of variance, SNK-q test was used for pairwise comparison and Pearson method was used for correlation analysis. Results The FPG, 2 h PG, HOMA-IR, HbA1C, ox-LDL-C levels of medium and severe SAHS sub-groups were significantly higher than those of non-SAHS group and light SAHS sub-group （P〈0.05）; and above indexes of severe SAHS sub-group were significantly higher than those of medium SAILS group （P〈0.05）; the differences of FPG, 2 h PG, HOMA-IR, HbA1C, ox-LDL-C levels between non-SAHS group and light SAHS sub-group were not significant （P〉0.05）. The TBIL and IBIL levels of medium and severe SAHS sub-groups were significantly lower than those of non-SAHS group and light SAHS sub-group （P〈0.05）; there were no significant differences of TBIL and IBIL levels between non-SAHS group and light SAHS sub-group （P〉0.05）. The correlation analysis showed that there was positive correlation between AHI and FPG, 2 h PG, HbA1C, HOMA-IR or ox-LDL-C （r values were 0.976, 0.986, 0.986, 0.987 and 0.960, respectively, P〈0.01）; there was negative correlation between LO2 and FPG, 2 h PG, HbA1C, HOMA-IR or ox-LDL-C （r values were -0.939, -0.976, -0.957, -0.986 and -0.913, respectively, P〈0.01 ）; there was no significant correlation between AHI or LO2 and TBIL or IBIL （P〉0.05）. Conclusion SAHS patients with coronary heart disease have the abnormal glucolipid metabolism and serum bilirubin levels, which may be the mechanism for promoting coronary heart disease.
作者
毛陇军
李英
强华
MAO Long-jun LI Ying QIANG Hua(Department of Cardio-cerebrovascular Disease, Baoji Central Hospital, Baoji, Shanxi Province 721008, China)
出处
《中国慢性病预防与控制》
CAS
2017年第5期337-340,共4页
Chinese Journal of Prevention and Control of Chronic Diseases
关键词
呼吸睡眠暂停低通气综合征
冠心病
糖脂代谢
胆红素
Respiratory apnea hypopnea syndrome
Coronary heart disease
Glucolipid metabolism
Bilirubin
