中国呼吸与危重监护杂志

中国呼吸与危重监护杂志

阻塞性睡眠呼吸暂停低通气综合征患者胰岛素抵抗状态及与外周血单个核细胞的内源性大麻素Ⅰ型受体蛋白表达的关系

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目的了解阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的糖代谢状态及其与内源性大麻素系统(ECS)的关系。方法共纳入 OSAHS 患者 64 例(轻度 18 例,中度 24 例,重度 22 例),对照 24 例。测量受试者体重指数、腰围、空腹血脂、血糖、血胰岛素、稳态模型评估的胰岛素抵抗指数(HOMA-IR)、多导睡眠图(PSG)监测指标以及外周血单个核细胞(PBMC)的内源性大麻素Ⅰ型受体(CB1R)蛋白表达情况。结果OSAHS 组中糖尿病及空腹血糖受损者比例显著高于对照组糖尿病及空腹血糖受损者的比例(28.12% 比 8.33%)。随着呼吸暂停低通气指数(AHI)升高,各组 HOMA-IR 及 PBMC 的 CB1R 蛋白表达量逐渐升高,对照组、轻度 OSAHS 组、中度 OSAHS 组及重度 OSAHS 组 HOMA-IR 和 CB1R 蛋白相对表达量分别为 2.40±0.90、2.34±0.59、2.94±0.99、3.46±0.77 和 0.04±0.01、0.37±0.09、0.40±0.07、0.62±0.14。相关分析显示 HOMA-IR、AHI 及 CB1R 蛋白表达水平彼此之间呈显著正相关关系(P<0.05)。结论OSAHS 患者容易发生胰岛素抵抗及空腹血糖受损和糖尿病,且可能与伴随着 OSAHS 的 ECS 状态活化密切相关。

ObjectiveTo investigate the relationship between glucose metabolism and endocannabinoid system (ECS) in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS).MethodsA total of 64 OSAHS patients (18 cases of mild OSAHS, 24 cases of moderate OSAHS, 22 cases of severe OSAHS) and 24 controls were included in the study. Body mass index, waist circumference, fasting blood lipids, fasting blood glucose, fasting blood insulin, homeostasis model of assessment for insulin resistance index (HOMA-IR), polysomnography and endogenous cannabinoid receptor 1 (CB1R) protein expression levels in peripheral blood mononuclear cells (PBMC) were measured in participants.ResultsThe incidence of diabetes and impaired fasting glucose (IFG) in the OSAHS group was significantly higher than that in the control group (28.12% vs. 8.33%). With the increase of apnea hypopnea index (AHI), HOMA-IR and the expression levels of CB1R protein increased gradually (HOMA-IR: 2.40±0.90, 2.34±0.59, 2.94±0.99, 3.46±0.77, respectively; CB1R protein: 0.04±0.01, 0.37±0.09, 0.40±0.07, 0.62±0.14, respectively). Correlation analysis showed that HOMA-IR, AHI and the expression of CB1R protein were significantly positively correlated with each other (P<0.05).ConclusionOSAHS patients are prone to insulin resistance, IFG and diabetes mellitus, which are closely related to the activation of ECS induced by OSAHS.

关键词: 阻塞性睡眠呼吸暂停低通气综合征; 胰岛素抵抗; 内源性大麻素; 糖尿病

Key words: Obstructive sleep apnea-hypopnea syndrome; Insulin resistance; Endocannabinoid; Diabetes mellitus

引用本文: 汪小亚, 濮家源, 白雪, 鲁文强, 冯涛. 阻塞性睡眠呼吸暂停低通气综合征患者胰岛素抵抗状态及与外周血单个核细胞的内源性大麻素Ⅰ型受体蛋白表达的关系. 中国呼吸与危重监护杂志, 2018, 17(4): 383-389. doi: 10.7507/1671-6205.201706024 复制

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