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目的探讨持续气道正压通气治疗对合并阻塞性睡眠呼吸暂停综合征(OSAS)的糖尿病患者心血管危险因素的影响,为临床干预提供参考依据。方法选取2014年3月至2016年3月于中国人民解放军白求恩国际和平医院内分泌科门诊就诊及住院治疗的2型糖尿病(T2DM)患者,通过行多导睡眠呼吸监测,筛选已确诊为OSAS者42例为研究对象,均给予夜间配戴简易呼吸机行持续气道正压通气治疗4周,以改变其睡眠呼吸暂停引起的缺氧情况,并观察和比较治疗前和治疗2周、4周后患者血糖、血脂、胰岛素抵抗及内皮素等反应心血管危险因素的指标变化。用SPSS 13.5软件包进行单因素方差分析,以LSD法进行组间比较。结果 42例研究对象中男性22例,女性20例,年龄为35~60岁,平均(43.0±8.0)岁,体质指数(BMI)为(30.2±3.4)kg/m2。与治疗前比较,治疗4周时空腹血糖(FPG)、餐后2 h血糖(2 h PG)水平下降,空腹胰岛素(FINS)和空腹C肽(C-P)分泌减少,胰岛素抵抗指数(HOMA-IR)下降,差异均有统计学意义(P<0.05,P<0.01)。与治疗前比较,治疗2周时患者的甘油三酯(TG)、内皮素(ET)水平下降,一氧化氮(NO)水平升高,差异均有统计学意义(P<0.05)。与治疗2周比较,治疗4周时患者的TG、ET水平持续下降,NO水平持续升高,差异均有统计学意义(P<0.05)。治疗4周时,同型半胱氨酸(Hcy)水平低于治疗前和治疗2周时,总胆固醇(TC)水平低于治疗前,差异均有统计学意义(P<0.05)。结论持续气道正压通气治疗可改善合并OSAS的T2DM患者的缺氧情况,从而有助于降低血糖水平,改善胰岛素抵抗及减少心血管危险因素。
Objective To investigate the effect of continuous positive airway pressure therapy on cardiovascular risk factors in patients with obstructive sleep apnea syndrome (OSAS) and provide a reference for clinical intervention. Methods From March 2014 to March 2016, patients with type 2 diabetes (T2DM) who were admitted to the Department of Endocrinology and Outpatient Department of Chinese People’s Liberation Army Bethune International Peace Hospital were selected for polysomnography and polysomnography 42 For example, the subjects were given a nighttime wearing simple ventilator continuous positive airway pressure therapy for 4 weeks to change the hypoxia caused by sleep apnea, and to observe and compare two weeks before treatment and after 4 weeks Patients with blood glucose, blood lipids, insulin resistance and endothelin and other cardiovascular risk factors response indicators. One-way analysis of variance (ANOVA) was performed using the SPSS 13.5 software package and LSD method was used to compare groups. Results Twenty-two male and 22 female patients, aged from 35 to 60 years old, averaged (43.0 ± 8.0) years old and body mass index (BMI) were (30.2 ± 3.4) kg / m2. Compared with those before treatment, fasting plasma glucose (FPG), 2 h PG level decreased, fasting insulin (FINS) and fasting C-peptide (CP) secretion decreased, insulin resistance index (HOMA-IR ) Decreased, the differences were statistically significant (P <0.05, P <0.01). Compared with those before treatment, the levels of triglyceride (TG) and endothelin (ET) and the level of nitric oxide (NO) increased at 2 weeks of treatment, with statistical significance (P <0.05). Compared with the 2 weeks of treatment, the levels of TG and ET continued to decline and the levels of NO continued to rise after 4 weeks of treatment, with statistical significance (P <0.05). After 4 weeks of treatment, the level of homocysteine (Hcy) was lower than that before treatment and 2 weeks after treatment, and the level of total cholesterol (TC) was lower than before treatment (P <0.05). CONCLUSION: Continuous positive airway pressure therapy can improve hypoxia in T2DM patients with OSAS, and thus help to reduce blood sugar level, improve insulin resistance and reduce cardiovascular risk factors.