儿童阻塞性睡眠呼吸暂停低通气综合征的糖脂代谢变化分析

目的 探讨儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)对糖脂代谢的影响。 方法 筛选2012年12月-2016年1月嘉兴市第二医院确诊为OSAHS的患儿52例和正常对照组儿童30例行多导睡眠呼吸监测,按PSG结果将OSAHS患儿分为轻度组39例和中重度组13例,所有受试儿童均检测空腹血糖(FPG)、血胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)等生化指标。分析各组糖脂代谢指标的差异,并与睡眠呼吸监测指标进行偏相关分析。 结果 OSAHS轻度组、中重度组BMI均高于正常对照组(P<0.05),最低动脉血氧饱和度(lowest SaO₂,LSaO₂)明显低于正常对照组(P<0.01),各组间呼吸暂停低通气指数(apnea hypopnea index,AHI)两两比较差异均具有统计学意义(P<0.01),OSAHS轻度组阻塞性呼吸暂停指数(obstructive apnea index,OAI)高于对照组(P<0.01);OSAHS中重度组患儿存在高胰岛素血症及胰岛素抵抗,但血糖基本维持在正常水平,该组FPG、FINS、HOMA-IR均高于OSAHS轻度组与正常对照组(P<0.05);各组间脂代谢指标比较差异均无统计学意义(均P>0.05);在控制BMI影响因素后,FINS及HOMA-IR与AHI呈显著正相关,与OAI、LSaO₂无相关关系,FPG与AHI、OAI、LSaO₂均不相关。 结论 儿童中重度OSHAS存在糖代谢紊乱,AHI是其致糖代谢紊乱的独立危险因素,所有OSHAS患儿脂代谢指标变化不明显。 

Changes of glucose and lipid metabolism in children with obstructive sleep apnea hypopnea syndrome

Objective To investigate the effect of obstructive sleep apnea hypopnea syndrome (OSAHS) on glucose and lipid metabolism in children. Methods A total of 52 OSAHS children and 30 normal children recruited as control group in our hospital were evaluated by polysomnography during sleep.According to the PSG results,OSAHS patients were divided into mild group (n=39) and moderate-to-severe group (n=13).The levels of fasting plasma glucose (FPG),fasting insulin (FINS),insulin resistance index (HOMA-IR),total cholesterol (TC),triglyceride (TG),high density lipoprotein cholesterol (HDL-C),low density lipoprotein cholesterol (LDL-C) were tested.The partial correlation analysis was performed to compare the glucose and lipid profiles and the indexes acquired from PSG monitoring. Results One way ANOVA showed statistically significant difference among BMI,AHI,OAI and LSaO₂.BMI of the two group OSAHS children was higher than control group (P<0.05),but LSaO₂ was significantly lower (P<0.01).OAI of mild OSAHS group was higher than that of the control group (P<0.01).Moderate-to-severe group children had hyperinsulinemia and insulin resistance,but the blood glucose maintained the normal level,FPG,FINS and HOMA-IR of this group were higher than that of mild OSAHS group and control group (P<0.05).There were no significant differences (P>0.05) in lipid metabolism index among the groups.After controlling the influence of BMI,there were significant positive correlations indicated between FINS,HOMA-IR and AHI.FPG had no correlation with AHI,OAI,and LSaO₂. Conclusion Moderate-to-severe group OSAHS can induce glucose metabolism disorder in children,AHI is an independent risk factor for the disorder of glucose metabolism,indicators of lipid metabolism in children with OSHAS did not change significantly.