论文部分内容阅读
目的探讨“Z”综合征患者睡眠呼吸暂停严重程度与血压类型及与胰岛素抵抗的关系。方法病例选择:共入选代谢综合征(MS)患者192例,根据多导睡眠监测结果将患者分为单纯代谢综合征组(MS,n=88),MS合并轻度阻塞性睡眠呼吸暂停综合征组(MS+轻OSAHS,n=53),MS合并中重度OSAHS组(MS+中重OSAHS,n=51),3组患者分别测定晨起空腹血糖、空腹胰岛素、血脂水平,进行24h动态血压监测,计算稳态模型胰岛素抵抗指数(HOMA-IR)。结果 “Z”综合征患者24h血压监测,全天特别是夜间平均血压明显高于MS组,“Z”综合征患者表现更多非杓型血压节律(P<0.05)。“Z”综合征患者,血脂谱异常主要表现为三酰甘油的升高及高密度脂蛋白胆固醇(HDL-C)的降低,而总胆固醇及低密度脂蛋白胆固醇(LDL-C)变化3组之间差异无统计学意义,且随着OSAHS的严重程度表现更为突出(P<0.05)。空腹胰岛素水平、HOMA-IR,“Z”综合征患者明显高于MS患者(P<0.05)。呼吸暂停低通气指数(AHI)与HOMA-IR及空腹胰岛素水平明显相关(P<0.01)。结论 “Z”综合征患者在MS的各组分表现均较MS患者更为突出,包括较高血压、非杓型血压比例增多、血脂分布特点及胰岛素抵抗程度。
Objective To investigate the relationship between the severity of sleep apnea and the type of blood pressure and insulin resistance in patients with “Z” syndrome. Methods: A total of 192 patients with metabolic syndrome (MS) were enrolled in this study. Patients were divided into simple metabolic syndrome group (MS, n = 88) and MS combined with mild obstructive sleep apnea syndrome (MS + light OSAHS, n = 53), MS combined with moderate and severe OSAHS group (MS + medium OSAHS, n = 51) .The fasting blood glucose, fasting insulin and blood lipid levels were measured in three groups. The homeostasis model insulin resistance index (HOMA-IR) was calculated. Results In the “Z” syndrome patients, blood pressure was monitored at 24 hours, and the mean blood pressure at all days, especially at night, was significantly higher than that in the MS group. Patients with “Z” syndrome showed more non-dipper blood pressure rhythms (P <0.05). In patients with “Z” syndrome, dyslipidemia was mainly manifested as the increase of triglyceride and the decrease of high density lipoprotein cholesterol (HDL-C), and the change of total cholesterol and low density lipoprotein cholesterol (LDL-C) The difference between the three groups was not statistically significant, and with the severity of OSAHS more prominent (P <0.05). Fasting insulin levels, HOMA-IR, and “Z” syndrome were significantly higher in patients with MS (P <0.05). Apnea hypopnea index (AHI) was significantly associated with HOMA-IR and fasting insulin (P <0.01). Conclusion “Z ” syndrome patients are more prominent in the performance of MS than MS patients, including higher blood pressure, non-dipper blood pressure increased proportion of blood lipid distribution and insulin resistance.