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目的探讨T2DM合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者在持续正压通气治疗(CPAP)前后血清视黄醇结合蛋白4(RBP4)及APN的变化规律。方法选取2014年6月至2016年10月于上海交通大学医学院附属同仁医院内分泌科、呼吸内科住院的T2DM合并OSAHS患者155例,随机分为CPAP治疗组(CPAP)73例和常规治疗对照组(Con)77例,测定治疗前、后12周呼吸参数变化,以及治疗前、治疗后4周、8周、12周的血清RBP4、APN、FPG、FIns,计算胰岛素抵抗指数(HOMAIR)。结果 CPAP组各项呼吸参数改善,血清APN升高程度高于Con组,4周、8周及12周分别为(7.92±3.15)vs(6.87±3.06)mg/L,(8.99±5.46)vs(7.15±3.20)mg/L,(11.68±4.65)vs(8.34±3.25)mg/L(F_(交互)=13.980,P=0.000),其升高程度随着治疗时间增加而增加(F_(时间)=26.574,P=0.000);血清RBP4降低程度低于Con组,4周、8周、12周分别为(22.10±2.82)vs(23.84±3.51)μg/L,(19.52±3.02)vs(22.98±4.07)μg/L,(16.43±2.56)vs(20.15±3.24)μg/L(F_(交互)=11.057,P=0.000),其降低幅度随着治疗时间增加而减少(F_(时间)=23.056,P=0.000)。结论 CPAP治疗能有效纠正T2DM合并OSAHS患者的低氧血症,改善IR,而RBP4和APN可作为监测病情转归、判断预后的有效指标。
Objective To investigate the changes of serum retinol binding protein 4 (RBP4) and APN in T2DM patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) before and after continuous positive airway pressure therapy (CPAP). Methods From June 2014 to October 2016, 155 patients with T2DM and OSAHS hospitalized in Department of Endocrinology and Respiratory Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine were randomly divided into CPAP group (CPAP), 73 cases and routine treatment control group (Con) 77 cases. The changes of respiratory parameters before and after 12 weeks and the serum RBP4, APN, FPG and FIns before treatment, 4 weeks, 8 weeks and 12 weeks after treatment were measured. The insulin resistance index (HOMAIR) was calculated. Results The respiratory parameters of CPAP group were improved and the level of serum APN was higher than that of Con group (7.92 ± 3.15 vs 6.87 ± 3.06 mg / L for 4 weeks, 8.99 ± 5.46 vs (7.15 ± 3.20) mg / L, (11.68 ± 4.65) vs (8.34 ± 3.25) mg / L (F_ (interaction) = 13.980, P = 0.000). The increased degree increased with the increase of treatment time (22.10 ± 2.82) vs (23.84 ± 3.51) μg / L, (19.52 ± 3.02) vs (P <0.05), and the serum level of RBP4 was lower than that of the Con group at 4 weeks, 8 weeks and 12 weeks (F = (22.98 ± 4.07) μg / L, (16.43 ± 2.56) vs (20.15 ± 3.24) μg / L, F_ (interaction) = 11.057, P = 0.000) ) = 23.056, P = 0.000). Conclusion CPAP can effectively correct hypoxemia and improve IR in patients with T2DM and OSAHS. RBP4 and APN can be used as effective indicators to monitor prognosis and prognosis.