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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 Sa O_2,LSa O_2)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、LSa O_2无相关关系,FPG与AHI、OAI、LSa O_2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。
Objective To investigate the effect of obstructive sleep apnea-hypopnea syndrome (OSAHS) on glucose and lipid metabolism in children. Methods Screening 52 children with OSAHS diagnosed in the Second Hospital of Jiaxing from December 2012 to January 2016 and 30 children with normal control group underwent polysomnographic sleep apnea screening. According to PSG results, the children with OSAHS were divided into mild group 39 cases and 13 cases of moderate and severe group, all of the tested children were tested for fasting blood glucose (FPG), insulin (FINS), insulin resistance index (HOMA-IR), serum total cholesterol (TC), triglyceride High-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and other biochemical indicators. The differences of glucose and lipid metabolism index in each group were analyzed, and partial correlation analysis with sleep-respiration monitoring index was made. Results The BMI of mild and moderate OSAHS group was significantly higher than that of normal control group (P <0.05), and the lowest SAO_2, LSa O_2 was significantly lower than that of normal control group (P <0.01) The apnea hypopnea index (AHI) was significantly different between the two groups (P <0.01), and the OSAHS mild obstructive apnea index (OAI) was higher than that of the control group <0.01). Hyperinsulinemia and insulin resistance were observed in moderate and severe OSAHS group, but the blood glucose level was maintained at normal level. The levels of FPG, FINS and HOMA-IR in OSAHS group were significantly higher than those in OSAHS mild group and normal control group (P < 0.05). There was no significant difference in lipid metabolism index between the two groups (all P> 0.05). FINS and HOMA-IR were positively correlated with AHI and had no correlation with OAI and LSa O 2 after controlling for BMI , FPG and AHI, OAI, LSa O_2 are not related. Conclusion There is disorder of glucose metabolism in children with moderate and severe OSHAS. AHI is an independent risk factor for the disorder of glucose metabolism. There is no obvious change of lipid metabolism in all children with OSHAS.