Page 61 - 中国全科医学2022-01

·186· http://www.chinagp.net E-mail:zgqkyx@chinagp.net.cn

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 LSaO 2 was significantly lower than the hypertension group. VAT，HOMA-IR and BMI were positively correlated
with AHI （P<0.05），and LSaO 2 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
2
were 0.763 and 0.926 when the diagnostic cut-off point was 100.5 cm . 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

阻塞性睡眠呼吸暂停低通气综合征（obstructive 价值。
sleep apnea hypopnea syndrome，OSAHS）是一种常见的 1 对象与方法
睡眠呼吸疾病，是因夜间反复发生呼吸暂停和低通气造 1.1 研究对象 选取 2019 年 1 月至 2020 年 7 月于昆
成慢性间歇低氧、二氧化碳潴留、正常睡眠结构和节律 明医科大学附属延安医院高血压中心就诊的高血压患者
破坏的综合征，亦是高血压、糖尿病和心脑血管疾病的 234 例，其中男 156 例、女 78 例；所有 OSAHS 患者符
重要危险因素 ［1-2］ 。SEGURO 等 ［3］ 学者研究发现，超 合中华医学会心血管病学分会诊断标准 ［8］ 。排除标准：
过 50% 的 OSAHS 患者合并高血压，而 30% 的高血压 （1）中枢性或混合性睡眠呼吸暂停低通气综合征；（2）
患者同时存在 OSAHS，难治性高血压患者中 OSAHS 发 继发性高血压；（3）已确诊糖尿病或已服用影响胰岛
病率超过 83%。随着社会进步，肥胖者数量越来越多， 素分泌的药物；（4）有严重心、脑、肺、肾、血管等
OSAHS 发病率明显升高，高血压合并 OSAHS 的发病率 方面疾病；（5）严重上气道、胸廓畸形。本研究经本
也逐年升高，但由于我国不同地域医疗条件的差异及 院伦理委员会审批（批号：2017-074-01）。
临床认识的不足，至今高血压合并 OSAHS 的诊断仍不 1.2 研究方法
足。本研究试图分析腹腔内脏脂肪面积（VAT）、稳态 1.2.1 临床指标 收集入选患者一般资料，包括性别、
模型胰岛素抵抗指数（HOMA-IR）与 OSAHS 的关系， 年龄、身高、体质量、颈围、腹围，计算体质指数（BMI）；
评估两者对高血压合并 OSAHS 的预测价值，使条件受 患者均行口服葡萄糖耐量试验（OGTT）、胰岛素释放
限地区能尽早筛查出高血压合并 OSAHS 人群，并尽早 实验，收集空腹血糖、空腹胰岛素，稳态模型评估胰岛
干预，从而降低心脑血管疾病严重并发症的发生风险。 素抵抗指数（HOMA-IR）= 空腹血糖（mmol/L）× 空
高血压合并 OSAHS 发病机制暂不明确，可能的机制 ［4-5］ 腹胰岛素（mU/L）/22.5。
包括间歇性缺氧、交感神经激活、肥胖、高瘦素血症、 1.2.2 VAT 测定 应用日本欧姆龙 Dual Scan HDS-2000
胰岛素抵抗、醛固酮水平升高、炎性应激、内皮功能紊 内脏脂肪检测仪，于患者空腹状态由指定专人进行操作，
乱、压力反射障碍等。相关研究显示，OSAHS 与脂肪 测定肚脐水平腹腔内脏脂肪和腹部皮下脂肪面积。
的异位堆积及胰岛素抵抗指数（IR）密切相关 ［6-7］ 。本 1.2.3 多导睡眠监测 白天避免影响夜间监测的活动
研究旨在探讨原发性高血压患者 VAT 及 HOMA-IR 与 （如日间睡眠过多、服用影响睡眠的药物及饮料等），
OSAHS 的关系，并评估其对高血压合并 OSAHS 的预测 应用德国索迪 SOMNOtouch RESP T9 对研究对象进行