腹腔内脏脂肪面积及稳态模型胰岛素抵抗指数对高血压合并阻塞性睡眠呼吸暂停低通气综合征的预测价值研究

doi:10.12114/j.issn.1007-9572.2021.01.040

摘要/Abstract

摘要： 背景高血压合并阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患病率逐年上升，但由于我国不同地域医疗条件的差异及临床认识的不足，至今高血压合并OSAHS的诊断仍不足。相关研究显示其发病机制与脂肪的异位堆积及胰岛素抵抗密切相关。目的本研究试图分析腹腔内脏脂肪面积（VAT）及稳态模型胰岛素抵抗指数（HOMA-IR）与OSAHS的关系，并评估其对高血压合并OSAHS的预测价值。方法选取2019年1月至2020年7月于昆明医科大学附属延安医院高血压中心就诊的高血压患者234例，患者均进行多导睡眠监测、VAT测定，并行葡萄糖耐量、胰岛素释放实验，计算HOMA-IR。根据睡眠呼吸暂停低通气指数（AHI）分为单纯高血压组（AHI<5次/h）27例及高血压合并OSAHS组（AHI≥5次/h）207例。分析两组间HOMA-IR、VAT水平，分别绘制HOMA-IR、VAT筛查高血压合并OSAHS受试者工作特征（ROC）曲线，分析ROC曲线下面积（AUC）及不同截断值的诊断价值；利用Logistic回归模型建模，用保存的概率作为单独变量绘制ROC曲线，分析二者联合预测高血压合并OSAHS的价值。结果高血压合并OSAHS组的VAT、HOMA-IR、BMI高于单纯高血压组，最低血氧饱和度（LSaO2）低于单纯高血压组（P<0.05）；VAT、HOMA-IR及BMI与AHI呈正相关（P<0.05），LSaO2与AHI呈负相关（P<0.05）。VAT预测高血压合并OSAHS的AUC（95%CI）为0.905（0.861，0.949），最佳截断值为100.5 cm2，灵敏度和特异度分别为0.763、0.926；HOMA-IR预测高血压合并OSAHS的AUC（95%CI）为0.813（0.725，0.900），最佳截断值为2.015，灵敏度和特异度分别为0.797、0.778；联合因子预测高血压合并OSAHS的AUC（95%CI）为0.917（0.871，0.963），最佳截断值为2.045，灵敏度和特异度分别为0.831、0.963。结论高血压合并OSAHS患者VAT和HOMA-IR明显高于单纯高血压患者，VAT和HOMA-IR对高血压合并OSAHS具有一定预测价值，可适用于无条件开展多导睡眠监测的医疗机构，以便尽早干预，进而降低心脑血管疾病严重并发症的发生风险。

关键词: 睡眠呼吸暂停, 阻塞性, 高血压, 腹内脂肪, 胰岛素抵抗, 稳态模型胰岛素抵抗指数, 预测

Abstract: Background

The prevalence of essential hypertension complicated with obstructive sleep apnea hypopnea syndrome (OSAHS) has been increasing year by year. However, due to the differences in medical conditions and lack of clinical understanding in different regions of China, the diagnosis of hypertension complicated with OSAHS is still insufficient. Relevant studies have shown that the pathogenesis of hypertension complicated with OSAHS is closely related to the ectopic accumulation of fat and insulin resistance.

Objective

This study attempted to analyze the relationship between OSAHS and abdominal visceral adipose tissue (VAT) and homeostasis model assessment of insulin resistance (HOMA-IR) , and their predictive value for hypertension complicated with OSAHS.

Methods

Two hundred and thirty-four patients with essential hypertension treated at hypertension center of Yan'an Hospital of Kunming Medical University from January 2019 to July 2020 were enrolled in the study. The HOMA-IR of the enrolled patients was calculated by polysomnography, VAT measurement, parallel glucose tolerance and insulin release experiments. According to the AHI level, 27 patients were divided into hypertension group (AHI<5 times/h) , and 207 patients were divided into hypertension complicated with OSAHS group (AHI≥5 times/h) . The levels of VAT and HOMA-IR were compared between 2 groups. The receiver operating characteristic (ROC) curve of screening hypertension patients complicated with OSAHS were determined by HOMA-IR and VAT, and the diagnosis value of area under AUC and different cut-off value were calculated. Logistic regression modeling was used to determine ROC curve with the saved probability as a separate variable to analyze the AUC of the two combined diagnosis of hypertension and OSAHS.

Results

The VAT, HOMA-IR and BMI of hypertension complicated with OSAHS group were significantly higher than the hypertension group, while LSaO₂ was significantly lower than the hypertension group. VAT, HOMA-IR and BMI were positively correlated with AHI (P<0.05) , and LSaO₂ was negatively correlated with AHI (P<0.05) . The AUC of ROC curve for the diagnosis of hypertension complicated with OSAHS by VAT was 0.905 〔95%CI (0.861, 0.949) 〕, and the sensitivity and specificity were 0.763 and 0.926 when the diagnostic cut-off point was 100.5 cm². The ROC curve AUC of HOMA-IR in the diagnosis of hypertension complicated with OSAHS was 0.813 〔95%CI (0.725, 0.900) 〕, when the diagnostic cut-off point was 2.015, the sensitivity and specificity were 0.797 and 0.778, respectively, and the AUC of ROC curve for combined factor diagnosis of hypertension complicated with OSAHS was 0.917 〔95%CI (0.871, 0.963) 〕, the diagnostic cut-off point was 2.045, the sensitivity and specificity were 0.831 and 0.963, respectively.

Conclusion

VAT and HOMA-IR in hypertension patients complicated with OSAHS are significantly higher than those in patients with hypertension. VAT and HOMA-IR have a certain predictive value for hypertension complicated with OSAHS, and can be applied to medical institutions that unconditionally carry out polysomnography, in order to intervene as early as possible to reduce the risk of serious complications of cardiovascular and cerebrovascular diseases.

Key words: Sleep apnea, obstructive, Hypertension, Intra-abdominal fat, Insulin resistance, Homeostasis model assessment of insulin resistance, Forecasting

中图分类号:

R563.8R544.1

甘露路,何燕,刘师节,等. 腹腔内脏脂肪面积及稳态模型胰岛素抵抗指数对高血压合并阻塞性睡眠呼吸暂停低通气综合征的预测价值研究[J]. 中国全科医学, 2022, 25(02): 185-188. DOI: 10.12114/j.issn.1007-9572.2021.01.040.

GAN Lulu, HE Yan, LIU Shijie, NI Qing, YANG Li.

The Value of Abdominal Visceral Adipose Tissue Area and Homeostasis Model Assessment of Insulin Resistance in Predicting Essential Hypertension Complicated with Obstructive Sleep Apnea Syndrome [J]. Chinese General Practice, 2022, 25(02): 185-188.

图/表 4

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组别	例数	性别（男/女）	年龄（±s，岁）	BMI（±s，kg/m²）	颈围（±s，cm）	腹围（±s，cm）	HOMA-IR（±s）	VAT（±s，cm²）	LSaO₂（±s，%）
单纯高血压组	27	13/14	52.6±10.7	23.52±2.48	34.8±2.35	86.87±7.59	1.77±1.02	73.26±20.05	87.41±3.74
高血压合并OSAHS组	207	143/64	50.7±12.4	27.12±3.74	39.13±3.39	98.51±9.97	3.40±2.08	129.33±43.66	74.03±11.15
t（χ²）值		3.09^a	0.75	-6.62	-6.42	-5.84	-6.70	-11.42	12.64
P值		0.08	0.36	<0.01	0.07	0.07	<0.01	<0.01	<0.01

组别	例数	性别（男/女）	年龄（±s，岁）	BMI（±s，kg/m²）	颈围（±s，cm）	腹围（±s，cm）	HOMA-IR（±s）	VAT（±s，cm²）	LSaO₂（±s，%）
单纯高血压组	27	13/14	52.6±10.7	23.52±2.48	34.8±2.35	86.87±7.59	1.77±1.02	73.26±20.05	87.41±3.74
高血压合并OSAHS组	207	143/64	50.7±12.4	27.12±3.74	39.13±3.39	98.51±9.97	3.40±2.08	129.33±43.66	74.03±11.15
t（χ²）值		3.09^a	0.75	-6.62	-6.42	-5.84	-6.70	-11.42	12.64
P值		0.08	0.36	<0.01	0.07	0.07	<0.01	<0.01	<0.01

检验统计量值	BMI	HOMA-IR	VAT	LSaO₂
r值	0.53	0.37	0.59	-0.77
P值	<0.01	<0.01	<0.01	<0.01

检验统计量值	BMI	HOMA-IR	VAT	LSaO₂
r值	0.53	0.37	0.59	-0.77
P值	<0.01	<0.01	<0.01	<0.01

自变量	B	SE	Waldχ²值	P值	OR值	95%CI
VAT	0.054	0.012	20.67	<0.01	1.06	（1.03，1.08）
HOMA-IR	0.610	0.288	4.49	0.03	1.84	（1.05，3.24）
常量	-4.489	1.057	18.04	<0.01	0.01	-