中国呼吸与危重监护杂志

中国呼吸与危重监护杂志

男性阻塞性睡眠呼吸暂停低通气综合征患者性激素水平与骨密度的相关性研究

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目的 探讨男性阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者骨密度改变以及与性激素水平的相关性。 方法 收集 2014 年 10 月至 2016 年 10 月在我院行多导睡眠图监测(PSG)确诊为 OSAHS 的 88 例男性患者,年龄 45~65 岁,并选择 30 例除外 OSAHS 的健康男性作为正常对照组。记录所有受试者一般资料及 PSG 参数,测定骨代谢指标以及腰椎、股骨颈骨密度,应用全自动化学发光免疫分析仪测定血清雌二醇、孕酮、睾酮、促卵泡生成素、促黄体生成素、泌乳素水平,比较两组间的差异并与骨密度进行相关性分析。 结果 OSAHS 组吸烟率、饮酒率、颈围、体重指数(BMI)均较对正常对照组明显升高,差异有统计学意义(均 P<0.05)。OSAHS 组骨代谢指标特异序列 β-骨胶原交联(β-CTX)水平较正常对照组显著升高[(0.53±0.14)ng/ml 比(0.47±0.15)ng/ml],腰椎[(0.92±0.12)g/cm2比(1.08±0.08)g/cm2]和股骨颈骨密度[(0.91±0.11)g/cm2比(1.06±0.13)g/cm2]较正常对照组显著降低,血清睾酮较正常对照组显著降低[(267.32±89.56)ng/dl 比(315.68±78.49)ng/dl],差异有统计学意义(均 P<0.05)。Pearson 相关性分析结果显示 AHI 与腰椎、股骨颈骨密度呈负相关(均P<0.001),LSaO2、睾酮与腰椎、股骨颈骨密度均呈正相关(均 P<0.01)。 结论 男性 OSAHS 患者有发生骨质疏松的风险,且与缺氧程度有关。血清睾酮下降可能是其原因之一。

Objective To ananlyze the relationship between bone mineral density and sex hormone in male patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods The study recruited 88 male patients with OSAHS aged 45-60 years in our hospital from October 2014 to October 2016 as an OSAHS group, and 30 healthy subjects without OSAHS as a control group. The general information and PSG parameters were recorded, the bone metabolic markers and bone mineral density of lumbar spine 1-4 (L1-4) and femoral neck (Neck) were measured, and the expressions of serum sex hormone (E2, P, T, FSH, LH and PRL) were determined by chemical luminescence immunity analyzer. The differences in above indexes between two groups and their correlation with bone mineral density were analyzed. Results Smoking rate, drinking rate, neck circumference and body mass index (BMI) of the OSAHS group were significantly higher than those of the control group. Compared with the control group, beta crosslaps (β-CTX, a bone metabolic marker) was significantly higher [(0.53±0.14) ng/ml vs. (0.47±0.15) ng/ml], the bone mineral density of L1-4 and Neck was significantly lower [(0.92±0.12) g/cm2 vs. (1.08±0.08) g/cm2, (0.91±0.11) g/cm2 vs. (1.06±0.13) g/cm2], and the serum testosterone was significantly lower in the OSAHS group [(267.32±89.56) ng/dlvs. (315.68±78.49) ng/dl] (all P<0.05). The result of Pearson correlation analysis showed that apnea hypopnea index (AHI) was negatively correlated with bone mineral density of L1-4 and Neck (bothP<0.001), lowest oxygen saturation (LSaO2) and testosterone were positively correlated with bone mineral density of L1-4 and Neck (all P<0.01). Conclusions The risk of suffering from osteoporosis is higher in male OSAHS patients and it is closely related to the degree of hypoxia. The decrease of testosterone may be one of the mechanisms.

关键词: 阻塞性睡眠呼吸暂停低通气综合征; 骨质疏松; 骨密度; 性激素; 睾酮

Key words: Obstructive sleep apnea hypopnea syndrome; Osteoporosis; Bone mineral density; Sex hormone; Testosterone

引用本文: 王赎, 熊晶, 刘焕兵, 余绍青, 方继伟, 付志云, 张伟. 男性阻塞性睡眠呼吸暂停低通气综合征患者性激素水平与骨密度的相关性研究. 中国呼吸与危重监护杂志, 2018, 17(1): 55-58. doi: 10.7507/1671-6205.201708060 复制

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