摘要
目的探讨阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)患者觉醒阈值(arousal threshold,ArTH)与代谢相关脂肪性肝病(metabolic-associated fatty liver disease,MAFLD)的相关性,并分析胰岛素抵抗评分、总胆固醇、白细胞、中性粒细胞、睡眠呼吸暂停低通气指数、氧减指数是否存在中介效应。方法选取襄阳市第一人民医院2020年1月至2023年12月确诊为OSA的患者329例,分为单纯OSA组(n=183),OSA合并MAFLD组(n=146)。收集所有患者的一般临床资料、多导睡眠监测(polysomnography,PSG)、血清学检查等相关指标,并采用以睡眠呼吸暂停低通气指数(apnea hypopnea index,AHI)、最低脉搏血氧饱和度(lowest saturation oxygen,LSpO_(2))及低通气呼吸事件比例作为评分标准的临床预测模型来判断OSA患者的ArTH。通过组间差异比较、二元Logistic回归分析探讨ArTH与MAFLD的关联,并验证中介效应。结果OSA组与OSA合并MAFLD组在BMI、性别、糖尿病、WBC、NEU、ALT、GGT、TC、TG、METS-IR、AHI、ODI、LSpO_(2)、MAI、MSpO_(2)、TS90%方面比较,差异均有统计学意义(均P<0.05),二元Logistic逐步回归分析显示,高ArTH(OR=2.777,95%CI:1.353~5.699,P=0.005)与OSA患者合并MAFLD风险显著相关。中介效应模型结果示METS-IR、WBC、NEU是高ArTH影响MAFLD的中介变量,METS-IR中介效应占比20.14%(P<0.01),WBC中介效应占比14.42%(P<0.01),NEU中介效应占比12.86%(P<0.01),而其他变量无中介效应。结论高ArTH与OSA患者合并MAFLD风险显著相关,其作用部分通过胰岛素抵抗、白细胞及中性粒细胞介导。
Objective To investigate the correlation between arousal threshold(ArTH)and metabolic-associated fatty liver disease(MAFLD)in patients with obstructive sleep apnea(OSA),and to analyze whether there is mediating effect on insulin resistance score,total cholesterol,white blood cells,neutrophils,sleep apnea hypopnea index and oxygen reduction index.Methods A total of 329 patients diagnosed with OSA in Xiangyang First People’s Hospital from January 2020 to December 2023 were selected and divided into the simple OSA group(183 cases)and the OSA combined with MAFLD group(146 cases).The general clinical data,polysomnography(PSG),serological examination and other related indicators of all patients were collected,and the clinical prediction model with apnea hypopnea index(AHI),lowest pulse oxygen saturation(LSpO_(2))and proportion of hypopnea events as scoring criteria was used to judge the ArTH of OSA patients.The association between ArTH and MAFLD was explored by comparison of differences between the two groups and binary logistic regression analysis,and the mediating effect was verified.Results There were significant differences in BMI,gender,diabetes,WBC,NEU,ALT,GGT,TC,TG,METS-IR,AHI,ODI,LSpO_(2),MAI,MSpO_(2),and TS90%between the simle OSA group and the MAFLD group(all P<0.05).Binary logistic stepwise regression analysis showed that high ArTH(OR=2.777,95%CI:1.353~5.699,P=0.005)was significantly associated with the risk of MAFLD in OSA patients.The results of the mediating effect model showed that insulin resistance,white blood cells and neutrophils were the mediating variables of high ArTH affecting MAFLD.The mediating effect of insulin resistance accounted for 20.14%(P<0.01),the mediating effect of white blood cells accounted for 14.42%(P<0.01),and the mediating effect of neutrophils accounted for 12.86%(P<0.01),while other variables had no mediating effect.Conclusion High ArTH is significantly associated with the risk of MAFLD in OSA patients,which is partially mediated by insulin resistance,white blood cells and neutrophils.
作者
元雪晗
朱敏
李平
陈俊文
YUAN Xuehan;ZHU Min;LI Ping;CHEN Junwen(Department of Respiratory and Critical care Medicine,Postgraduate Union Training Base of Xiangyang No.1 People’s Hospital,School of Medicine of Wuhan University of Science and Technology,Xiangyang,Hubei 441000,China;Department of Respiratory and Critical care Medicine,Xiangyang No.1 People's Hospital Affiliated to Hubei University of Medicine,Xiangyang,Hubei 441000,China)
出处
《临床肺科杂志》
2026年第2期202-208,共7页
Journal of Clinical Pulmonary Medicine
基金
湖北省自然科学基金联合基金(JCZRLH202501294)
湖北省重点实验室开放基金(OHIC2024Z05)
襄阳市第一人民医院重点专项科研基金(XYY2022-323)。
关键词
睡眠呼吸暂停
代谢相关脂肪性肝病
觉醒阈值
中介效应
sleep apnea
metabolic-related fatty liver disease
arousal threshold
mediating effect
