非肥胖型阻塞性睡眠呼吸暂停低通气综合征的血脂变化研究

目的探讨非肥胖型阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的血脂代谢紊乱、患病率及发病因素。方法以睡眠鼾症门诊278例鼾症患者为观察对象,行多导睡眠监测(PSG),根据患者的肥胖程度及睡眠呼吸暂停低通气指数(AHI)水平分为肥胖非OSAHS组(肥胖单纯鼾症组)、非肥胖OSAHS组和肥胖OSAHS组,设非肥胖单纯鼾症组为对照组。并采集次日清晨外周血,测定血脂水平,包括血清三酰甘油、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇。比较各组之间血脂水平的差异,对比OSAHS组和单纯鼾症组患病率,分析氧减程度和高脂血症患病率的关系。结果 278例患者(男性186例,占66.91%)中,212例为OSAHS患者,非肥胖OSAHS组、肥胖单纯鼾症组和肥胖OSAHS组三酰甘油和总胆固醇水平均高于正常对照组,差异有统计学意义(P<0.05),并且肥胖OSAHS组三酰甘油和总胆固醇水平显著高于其他三组,差异有统计学意义(P<0.05);其他各组间比较差异均无统计学意义(P>0.05)。OSAHS组高脂血症的患病率高于单纯鼾症组,但差异无统计学意义(P>0.05)。高胆固醇血症的患病率男性明显高于女性,差异有统计学意义(52.82%vs.11.43%,P<0.05);低高密度脂蛋白血症的患病率男性低于女性,差异有统计学意义(26.76%vs.41.43%,P<0.05);血氧饱和度减低指数(DI)是总胆固醇和三酰甘油增高的独立发病因素,DI和总胆固醇水平(r=0.276,P<0.05)以及三酰甘油水平(r=0.219,P<0.05)均呈正相关。结论高脂血症的患病率在OSAHS患者人群中增高,非肥胖OSAHS患者中部分血脂指标增高,慢性间歇性缺氧可能是非肥胖OSAHS患者高脂血症的发病因素。

Lipid Metabolism Disorder in Non-obese Type Obstructive Sleep Apnea Hypopnea Syndrome

Objective To study the prevalence of lipid metabolism disorders and the risk factors in non-obese patients with obstructive sleep apnea hypopnea syndrome(OSAHS).Methods Totally 278 patients with snoring symptoms chosen were given polysomnogram(PSG) monitoring.They were separated into four groups according to apnea hypopnea index(AHI) and fat degree:obese non-OSAHS group,non-obese OSAHS group,obese OSAHS group,and non-obese non-OSAHS(control group).Peripheral blood was collected from every patients in morning after fasting Blood lipid indexes including plasma triglycerides(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C) and low density lipoprotein cholesterol(LDL-C) were measured.The blood lipid levels between groups were compared and the prevalence of lipid metabolism disorders between the OSAHS and simple snoring groups were compared.And the relationship between oxygen desaturation index and hyperlipidemia prevalence also be discussed.Results Of the 278 patients(186 were male,accounting for 66.91%),212 were diagnosed with OSAHS(AHI>5/h).The levels of TG and TC were higher in the non-obese OSAHS group,obese non-OSAHS group and obese OSAHS group than in the control group(P<0.05),and significant higher in the obese OSAHS group than in the other 3 groups(P<0.05),but no statistically significance was found between other groups(P>0.05).The prevalence of hyperlipidemia was higher in the OSAHS groups than in the control group,but with no statistical significance(P>0.05).The prevalence hypercholesterolemia was higher in males than in females(52.82% vs.11.43%,P<0.05).The prevalence of low high density lipoproteins was lower in males than in females(26.76% vs.41.43%,P<0.05).The oxygen desateration index was an independent risk factor for the increases of TG and TC,and it was positively correlated with TC(r=0.276,P<0.05) and TG(r=0.219,P<0.05).Conclusion The prevalence of hyperlipidemia is higher in patients with OSAHS.The indexes of parts of lipid indexes in non-obese OSAHS patients are higher,and chronic intermittent hypoxemia may be the risk factors for the patients to have hyperlipidemia.