2型糖尿病患者血清鸢尾素、摄食抑制因子-1、3-硝基酪氨酸水平与糖脂代谢和阻塞性睡眠呼吸暂停低通气综合征的关系研究

摘要 目的：探讨2型糖尿病（T2DM）患者血清鸢尾素（Irisin）、摄食抑制因子-1（Nesfatin-1）、3-硝基酪氨酸（3-NT）水平与糖脂代谢和阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的关系。方法：选择2020年4月~2021年9月期间中国人民解放军总医院京南医疗区收治的T2DM患者80例作为研究对象，根据多导睡眠图（PSG）检查结果，合并OSAHS的51例患者列为T2DM合并OSAHS组，剩余的29例纳为T2DM未合并OSAHS组。选择同期来中国人民解放军总医院京南医疗区体检的40例健康志愿者作为对照组。对比T2DM患者、对照组的Irisin、Nesfatin-1、3-NT水平，采用Pearson相关性分析显示Irisin、Nesfatin-1、3-NT与糖脂代谢指标的相关性。T2DM患者发生OSAHS的影响因素采用多因素Logistic回归分析。结果：T2DM合并OSAHS组、T2DM未合并OSAHS组Irisin低于对照组，且T2DM合并OSAHS组低于T2DM未合并OSAHS组（P<0.05）。T2DM合并OSAHS组、T2DM未合并OSAHS组Nesfatin-1、3-NT高于对照组，且T2DM合并OSAHS组高于T2DM未合并OSAHS组（P<0.05）。T2DM合并OSAHS组、T2DM未合并OSAHS组糖化血红蛋白（HbAlc）、空腹血糖（FBG）、餐后2 h血糖（2hPG）高于对照组，且T2DM合并OSAHS组高于T2DM未合并OSAHS组（P<0.05）。T2DM合并OSAHS组、T2DM未合并OSAHS组三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、总胆固醇（TC）较对照组高，高密度脂蛋白胆固醇（HDL-C）低于对照组（P<0.05）。Pearson相关性分析结果显示，Irisin与HbAlc、FBG、2hPG呈负相关，Nesfatin-1、3-NT与HbAlc、FBG、2hPG呈正相关（P<0.05）。T2DM合并OSAHS组、T2DM未合并OSAHS组的年龄、合并高血压、体质量指数、AHI、空腹C肽、合并冠心病对比有差异（P<0.05）。Irisin、Nesfatin-1、3-NT、HbAlc、FBG、2hPG、年龄、合并高血压是T2DM患者发生OSAHS的影响因素（P<0.05）。结论：T2DM合并OSAHS患者的Irisin、Nesfatin-1、3-NT水平表达异常，参与着机体的糖脂代谢过程及OSAHS发生，且OSAHS发生同时还受到HbAlc、FBG、2hPG、年龄、合并高血压的影响，可考虑对上述因素进行早期监测，以进行相关干预。

Relationship Study between Serum Irisin, Nesfatin-1 and 3- Nitrotyrosine Levels in Patients with Type 2 Diabetes Mellitus and Glucose and Lipid Metabolism and Obstructive Sleep Apnea Hypopnea Syndrome

ABSTRACT Objective: To investigate the relationship between serum Irisin (Irisin), Nesfatin-1 (Nesfatin-1) and 3-nitrotyrosine (3-NT) levels in type 2 diabetes mellitus (T2DM) and glucose and lipid metabolism and obstructive sleep apnea hypopnea syndrome (OSAHS). Methods: 80 patients with T2DM who were treated in Jingnan Medical College of the General Hospital of the Chinese people''s Liberation Army from April 2020 to September 2021 were selected as the research object. According to the results of polysomnography (PSG), 51 patients with OSAHS were identified as T2DM combined with OSAHS group, and the remaining 29 patients were included as T2DM without OSAHS group. 40 healthy volunteers who came to Jingnan Medical College of the General Hospital of the Chinese people''s Liberation Army for physical examination in the same period were selected as the control group. The Irisin, Nesfatin-1 and 3-NT levels in T2DM patients and control group were compared. Pearson correlation analysis showed the correlation between Irisin, Nesfatin-1 and 3-NT and glucose and lipid metabolism indexes. The influencing factors of OSAHS in patients with T2DM were analyzed by multivariate Logistic regression. Results: Irisin in T2DM combined with OSAHS group and T2DM without OSAHS group was lower than that in the control group, and irisin in T2DM combined with OSAHS group was lower than that in T2DM without OSAHS group (P<0.05). Nesfatin-1 and 3-NT in T2DM combined with OSAHS group and T2DM without OSAHS group were higher than those in the control group, and those in T2DM combined with OSAHS group were higher than those in T2DM without OSAHS group (P<0.05). Glycosylated hemoglobin (HbAlc), fasting blood glucose (FBG) and 2h postprandial blood glucose (2hPG) in T2DM combined with OSAHS group and T2DM without OSAHS group were higher than those in control group, and those in T2DM combined with OSAHS group were higher than those in T2DM without OSAHS group (P<0.05). Triglyceride (TG), low density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) in T2DM combined with OSAHS group and T2DM without OSAHS group were higher than those in control group, while high density lipoprotein cholesterol (HDL-C) was lower than those in control group (P<0.05). Pearson correlation analysis showed that Irisin was negatively correlated with HbAlc, FBG and 2hPG, while Nesatin -1 and 3-NT were positively correlated with HbAlc, FBG and 2hPG (P<0.05). There were significant differences in age, hypertension, body mass index, AHI, fasting C-peptide and Complicated coronary heart disease between T2DM combined with OSAHS group and T2DM without OSAHS group (P<0.05). Irisin, Nesfatin-1, 3-NT, HbAlc, FBG, 2hPG, age and combined with hypertension were the influencing factors of OSAHS in T2DM patients (P<0.05). Conclusion: The abnormal expression of Irisin, Nesfatin-1 and 3-NT in T2DM patients with OSAHS is involved in the process of glucose and lipid metabolism, OSAHS occurrence. At the same time, OSAHS occurrence also affected by HbAlc, FBG, 2hPG, age, hypertension. Early detection of the above indicators can be considered for relevant intervention.