2019 年第 11 期 第 14 卷

男性糖尿病合并冠状动脉粥样硬化性心脏病患者发生阻塞性睡眠呼吸暂停的危险因素

Risk factors analysis of obstructive sleep apnea in male patients with diabetes mellitus and coronary atherosclerotic heart disease

作者：汤雅迪周迎生

英文作者：

单位：100029首都医科大学附属北京安贞医院内分泌代谢科北京市心肺血管疾病研究所

英文单位：

关键词：糖尿病；冠状动脉粥样硬化性心脏病；阻塞性睡眠呼吸暂停

英文关键词：

• 摘要：

• 【摘要】目的    探讨男性糖尿病合并冠状动脉粥样硬化性心脏病（冠心病）患者发生阻塞性睡眠呼吸暂停(OSA)的危险因素。方法    收集2015年1月1日至2018年6月30日在首都医科大学附属北京安贞医院行睡眠呼吸监测的211例男性糖尿病合并冠心病患者的临床资料，其中有OSA患者177例（OSA组）、无OSA患者34例（对照组）。比较分析2组患者的一般临床特征、实验室检查、冠状动脉造影及睡眠呼吸监测等结果。采用多因素Logistic回归分析筛选OSA的危险因素。OSA患者中肥胖者68例、非肥胖109例，OSA分为轻度［睡眠呼吸暂停低通气指数(AHI)5～＜15次/h］和中重度(AHI≥15次/h)，比较不同组类患者的相关检查结果。结果    OSA组体重指数、高脂血症比例、总胆固醇、高敏C反应蛋白（hs-CRP）水平高于对照组［（27.3±2.7）kg/m2比（25.6±2.2）kg/m2、20.9%（37/177）比5.9%（2/34）、（4.1±1.0）mmol/L比（3.7±0.9）mmol/L、3.1(0.8，6.6)mg/L比1.3(0.4，4.1)mg/L］，差异均有统计学意义（均P<0.05）。其中体重指数(比值比=1.243，95%置信区间：1.065～1.451，P=0.006)是OSA的独立危险因素，ROC曲线分析得出体重指数最佳切点为26.6 kg/m2,有助于筛查OSA。非肥胖患者中重度OSA组三酰甘油、糖化血红蛋白、空腹血糖、hs-CRP水平及中性粒细胞百分比高于轻度OSA组，差异均有统计学意义（均P<0.05）；肥胖患者中重度OSA组的冠状动脉多支血管病变比例大于轻度OSA组，差异有统计学意义（P<0.05）。结论    体重指数是男性糖尿病合并冠心病患者发生OSA的独立危险因素，肥胖患者OSA越严重冠状动脉多支病变发生率越高。

• 【Abstract】Objective    To investigate the risk factors analysis of obstructive sleep apnea(OSA) in male patients with diabetes mellitus and coronary atherosclerotic heart disease. Methods    From January 1st 2015 to June 30th, 2018, 211 male patients with diabetes mellitus and coronary atherosclerotic heart disease underwent sleep monitoring for breathing disorder in Beijing Anzhen Hospital, Capital Medical University, including 177 patients with OSA(OSA group) and 34 patients without OSA(control group). General information, laboratory results, coronary angiography findings and sleep monitoring parameters were retrospectively analyzed. Risk factors of OSA were screened by multivariate logistic regression. In OSA group there were 68 obese patients and 109 non-obese patients. OSA was graded as mild［sleep apnea hypopnea index(AHI) 5-＜15 events/h］ and moderate-to-severe(AHI≥15 events/h). Results    OSA group had higher body mass index, prevalence rate of hyperlipidemia, total cholesterol and high sensitive C-reactive protein levels than control group［（27.3±2.7）kg/m2 vs （25.6±2.2）kg/m2, 20.9%（37/177） vs 5.9%（2/34）, （4.1±1.0）mmol/L vs （3.7±0.9）mmol/L, 3.1(0.8，6.6)mg/L vs 1.3(0.4，4.1)mg/L］(all P<0.05). Body mass index was an independent risk factor of OSA(odds ratio=1.243, 95% confidence interval: 1.065-1.451, P=0.006). The optimal cut-off value of BMI in predicting OSA was 26.6 kg/m2 according to the receiver operator characteristic curve. Among non-obese patients there were higher levels of triglyceride, glycosylated hemoglobin, fasting blood sugar, high sensitive C-reactive protein and neutrophil percentage in patients with moderate-to-severe OSA as compared with patients with mild OSA(all P<0.05). Among obese patients there was higher incidence of coronary multivessel disease in patients with moderate-to-severe OSA as compared with patients with mild OSA(P<0.05). Conclusions    Body mass index is an independent risk factor of OSA in male patients with diabetes mellitus and coronary atherosclerotic heart disease. Obese patients have higher incidence of coronary multivessel disease with more severe OSA.