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目的:探讨长期nCPAP治疗对合并中重度OSAHS的2型DM患者胰岛素抵抗及血清瘦素(leptin)水平的影响。方法:选取多导睡眠监测(PSG)确诊的中重度OSAHS伴2型DM患者且对nCPAP治疗依从性好者50例进行6个月的nCPAP,治疗前后检测其FGB、HbA1c、胰岛素敏感性指标及血清leptin水平,采用配对t检验进行比较、评价。结果:(1)nCPAP治疗后受试者FGB[(7.5±1.8)mmol/L]、HbA1c[(7.0±1.4)%]和leptin水平[(9.6±5.2)ng/ml]较治疗前FGB[(9.7±2.2)mmol/L]、HbA1c[(8.6±2.0)%]和leptin[(14.9±8.8)ng/ml]显著降低(t=9.348,P<0.001;t=10.598,P<0.001;t=6.086,P<0.001);(2)治疗后胰岛素抵抗(IR)的稳态模式评估指数(HOMA-IR)(2.4±1.1)显著降低(t=3.140,P<0.01)。结论:nCPAP可改善合并中重度OSAHS的2型DM患者的血糖控制,降低瘦素水平,增加其胰岛素敏感性。
Objective: To investigate the effect of long-term nCPAP treatment on insulin resistance and serum leptin level in type 2 DM patients with moderate-severe OSAHS. Methods: Fifty patients with severe OSAHS with type 2 DM confirmed by polysomnography (PSG) and with good adherence to nCPAP were enrolled for nCPAP for 6 months. The levels of FGB, HbA1c and insulin sensitivity were measured before and after treatment. Serum leptin levels, using paired t-test to compare and evaluate. Results: (1) The levels of FGB [(7.5 ± 1.8) mmol / L], HbA1c (7.0 ± 1.4)% and leptin in the patients with nCPAP [(9.6 ± 5.2) ng / (9.7 ± 2.2) mmol / L], HbA1c [(8.6 ± 2.0)%] and leptin [(14.9 ± 8.8) ng / ml] t = 6.086, P <0.001). (2) HOMA-IR (2.4 ± 1.1) was significantly lower (t = 3.140, P <0.01) after treatment. CONCLUSIONS: nCPAP improves glycemic control, reduces leptin levels, and increases insulin sensitivity in type 2 DM patients with moderate-to-severe OSAHS.