【作者】 李春梅；

【导师】 任寿安；

【作者基本信息】 山西医科大学 ， 呼吸内科学， 2010， 硕士

【摘要】 目的：通过检测阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血清血管生成素样蛋白4(Angpt14)水平,研究它与人体参数及脂代谢各指标的关系,探讨Angpt14与OSAHS的关系及其在OSAHS发病机制中的作用。方法：所有研究对象均来自于2009年4月至2010年1月在山西医科大学第一医院就诊的患者,均行7小时多导睡眠图(PSG)监测系统进行监测。按入院时间先后,选择确诊OSAHS的患者50例为OSAHS组。OSAHS患者根据《中华结核和呼吸杂志》2002年4月发表的“阻塞性睡眠呼吸暂停低通气综合征诊治指南(草案)”确诊,排除由小颌畸形、鼻中隔偏曲等解剖因素所致者,及糖尿病、高血压病、冠心病、脑梗死、动脉粥样硬化、肿瘤、手术应激、慢性肾病、其他慢性缺氧性疾病,伴有心、肾功能衰竭等严重并发症及正在口服降脂药的病例。选择年龄、民族、性别与相应OSAHS患者匹配,PSG监测未达到OSAHS诊断标准的正常人35名为健康对照组。分别采取OSAHS病例组及健康对照组的基线资料及清晨空腹静脉血,酶联免疫法测定OSAHS病例组和健康对照组的血清Angpt14水平,生化法测定血脂。最后进行相关统计分析。结果：1.OSAHS组与健康对照组年龄、性别无显著性差异(P＞0.05)。与健康对照组相比,OSAHS组颈围、腹围、BMI、腰髋比明显增大(P<0.01), TC、TG、LDL-C、Angpt14明显升高(P<0.01), HDL-C明显降低(P<0.01)。OSAHS组较健康对照组AHI、最低SO2＜90%时间明显增加(p＜0.05),最低血氧饱和度及平均血氧饱和度较正常对照组显著降低(p<0.05)。2.TG、LDL-C与AHI呈显著正相关,HDL-C与AHI呈负相关。控制BMI及年龄后,TG仍与AHI呈显著正相关。3.BMI、颈围、腹围、腰围、臀围、腰髋比均与AHI呈显著正相关。控制BMI后,颈围、腹围、腰围、腰髋比仍与AHI呈显著正相关。4. OSAHS组中血清Angpt14浓度与颈围、腹围、腰围呈显著正相关(P＜0.05),而与BMI、腰髋比无显著相关性(P＞0.05)。OSAHS组中血清Angpt14浓度与AHI、最低SO2＜90%时间呈正相关(p＜0.05),与平均SO2、最低SO2呈显著负相关(p＜0.05)。OSAHS组中血清Angpt14浓度与HDL-C呈显著负相关(p＜0.05),与TG呈显著正相关(p＜0.05),而与TC、LDL-C无显著相关性。结论：1. OSAHS与肥胖密切相关,颈围、腰围、腹围是OSAHS病情严重程度的独立预测指标。OSAHS患者存在脂代谢紊乱,并且TG独立于肥胖和年龄之外与AHI相关,即高甘油三酯血症越严重,OSAHS病情越严重。2. OSAHS患者血清Angpt14明显升高,且其浓度能反映OSAHS病情的严重程度及低氧血症的严重程度。3. Angpt14可能参与OSAHS患者脂代谢紊乱的形成。4. OSAHS患者血清Angpt14水平与颈围、腰围、腹围等正相关,可能是Angpt14在不同部位脂肪组织中特异分布的结果。更多还原

【Abstract】 Objective:The aim of the study was to explore the association between serum Angptl4 and OSAHS severity, and to investigate the role of Angptl4 in OSAHS.Methods:Eighty-five cases examined with polysomnography were intermittently selected from the patients in The First Hospital of Shanxi Medical University and divided in two groups. The test group was OSAHS patients, which had 50 cases. All the patients were diagnosed according to the criteria in the Chinese Journal of Tuberculosis and Respiratory in April of 2002, and the cases caused by non-obesity factors or accompanied severe complications, such as diabetes mellitus, hypertension, cardiovascular or cerebrovascular disease, heart failure, tumor, liver, inflammatory or other chronic disease, use of systemic medication, were eliminated. The control group was healthy people, which had 35 cases. Patients with OSASH and healthy controls, underwent a biochemical analysis to estimate fasting levels of Angptl4 and lipid profile.Results:1.The two groups were matched for age and gender. The Neck circumference, Waist circumference, BMI, Waist-to-hip ratio, TC, TG, LDL-C and Angptl4 level in serum of OSAHS patients was higher than that of the control group(P<0.05). The HDL-C level was lower than the control group(P<0.05).By definition, the AHI of OSAHS Group was higher than that of Healthy Group (p<0.05). Also, minimum and average SO2 during sleep were lower in sleep apneic patients compared to normal controls (p<0.05 respectively), while time spent in SO2 <90% during sleep was significantly greater in OSAHS group (p<0.05).2. TG, LDL-C correlated positively with AHI. After controlling for BMI and age, TG still correlated positively with AHI.3. BMI, neck circumference, waist circumference and waist-to-hip ratio correlated positively with AHI. After controlling for BMI, neck circumference, waist circumference and Waist-to-hip ratio still correlated positively with AHI.4. In OSASH patients, Angpt14 levels correlated positively with neck circumference, waist circumference, AHI, time spent in SO2<90% and triglyceride levels (p<0.05) and negatively with minimum SO2 average SO2 and HDL cholesterol levels (p<0.05,respectively). No association was found, however, between Angpt14 levels and BMI or LDL-C.Conclusion:1.Obstructive sleep apnea is closely associated with obesity. And neck circumference, abdominal girth, waist circumference, waist-to-hip ratio are the risk factors for OSAHS. OSAHS is associated with impaired lipid metabolism. After controlling for BMI and age, TG still correlated positively with AHI. So higher blood triglyceride levels, severe the OSAHS is.2. In OSAHS patients, serum Angpt14 levels are significantly higher than the control group.3. Angpt14 may contribute to the impaired lipid metabolism in OSAHS patients.4. In OSASH patients, Angpt14 levels correlated positively with neck circumference, abdominal girth, waist circumference. It may suggested that Angpt14 of adipose tissue may indeed depend on its location within the body.更多还原