Effect of exenatide on hypoxia status of patients with type 2 diabetes mellitus complicated with obstructive sleep apnea hypopnea syndrome
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摘要: 目的 探讨艾塞那肽对2型糖尿病合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者缺氧状态的影响。 方法 选取2型糖尿病合并OSAHS患者43例,随机分为A组21例(使用预混胰岛素治疗)、B组22例(使用艾塞那肽治疗)。比较2组患者治疗前后代谢指标和缺氧指数变化情况。 结果 B组有2例患者因严重胃肠道反应脱落。与治疗前相比, 2组治疗后糖化血红蛋白(HbA1C)、餐后2 h血糖(2 h PG)、胰岛素抵抗指数(HOMA-IR)显著下降, A组空腹血糖(FPG)显著下降(P<0.05)。与A组比较, B组HOMA-IR较低, FPG较高,差异有统计学意义(P<0.05)。与治疗前比较, B组患者治疗后收缩压(SBP)、腰围(WC)、体质量指数(BMI)、体质量、肝脏脂肪含量(LFC)、低密度脂蛋白胆固醇(LDL-C)显著下降,且与A组比较有显著差异(P<0.05)。2组治疗前缺氧指标均无显著差异(P>0.05)。B组治疗后氧减指数(ODI)显著下降,夜间最低血氧饱和度(LSpO2)显著升高(P<0.05), 且B组LSpO2显著高于A组(P<0.05)。矫正性别、年龄后, B组患者初诊时临床代谢指标与缺氧指标变化的偏相关分析结果显示,初诊的WC与△ODI呈显著正相关(P<0.05), BMI、血肌酐(SCr)与△LSpO2呈显著正相关(P<0.05), 估算肾小球滤过率(eGFR)与△LSpO2呈显著负相关(P<0.05)。 结论 单用艾塞那肽治疗可以改善2型糖尿病合并OSAHS患者的血糖、血脂、胰岛素抵抗、ODI和LSpO2。Abstract: Objective To explore the effect of exenatide on hypoxia status of patients with type 2 diabetes mellitus complicated with obstructive sleep apnea hypopnea syndrome(OSAHS). Methods Forty-three patients with type 2 diabetes mellitus complicated with OSAHS were selected and randomly divided into group A(n=21)and group B(n=22). Group A was treated with premixed insulin, and group B was treated with exenatide. The changes of metabolic indexes and hypoxia indexes before and after treatment were compared between the two groups. Results In group B, two cases were removed due to severe gastrointestinal reactions. Compared with those before treatment, the levels of glycosylated hemoglobin(HbA1C), 2-hour postprandial blood glucose(2 h PG)and insulin resistance index(HOMA-IR)after treatment in both group were significantly lower, and fasting blood glucose(FPG)in group A was significantly lower(P<0.05). Compared with group A, HOMA-IR was significantly lower and FPG was significantly higher in group B(P<0.05). Compared with before treatment, systolic blood pressure(SBP), waist circumference(WC), body mass index(BMI), body mass, liver fat content(LFC)and low density lipoprotein cholesterol(LDL-C)- decreased significantly after treatment in group B, and there were significant differences between group B and group A(P<0.05). There were no significant differences in hypoxia indexes before treatment between the two groups(P>0.05). After treatment, oxygen reduction index(ODI)decreased significantly and the lowest oxygen saturation at night(LSpO2)increased significantly in group B(P<0.05), and LSpO2 in group B was significantly higher than that in group A(P<0.05). After correction of gender and age, the partial correlation analysis of clinical metabolic indexes and hypoxia indexes at first visit in group B showed that WC was positively correlated with △ODI(P<0.05), BMI, serum creatinine(SCR)was positively correlated with △LSpO2(P<0.05), and estimated glomerular filtration rate(eGFR)was negatively correlated with △LSpO2(P<0.05). Conclusion Exenatide alone can improve blood glucose, blood lipid, insulin resistance, ODI and LSpO2 in patients with type 2 diabetes mellitus and OSAHS.
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中华医学会呼吸病学分会睡眠呼吸疾病学组. 阻塞性睡眠呼吸暂停低通气综合征诊治指南(草案)[J]. 现代实用医学, 2003, 15(3): 192-195. Fredheim J M, Rollheim J, Omland T, et al. Type 2 diabetes and pre-diabetes are associated with obstructive sleep apnea in extremely obese subjects: a cross-sectional study[J]. Cardiovasc Diabetol, 2011, 10: 84-89.
Steiropoulos P, Papanas N, Nena E, et al. Markers of glycemic control and insulin resistance in non-diabetic patients with Obstructive Sleep Apnea Hypopnea Syndrome: does adherence to CPAP treatment improve glycemic control?[J]. Sleep Med, 2009, 10(8): 887-891.
Cuhadaroglu C, Utkusavas A, Öztürk L, et al. Effects of nasal CPAP treatment on insulin resistance, lipid profile, and plasma leptin in sleep apnea[J]. Lung, 2009, 187(2): 75-81.
Lean M E, Carraro R, Finer N, et al. Tolerability of nausea and vomiting and associations with weight loss in a randomized trial of liraglutide in obese, non-diabetic adults[J]. Int J Obes(Lond), 2014, 38(5): 689-697.
胡文, 倪耀军. 阻塞性睡眠呼吸暂停综合征合并2型糖尿病血糖管理[J]. 临床肺科杂志, 2012, 17(8): 1412-1414. 何权瀛, 陈宝元. 阻塞性睡眠呼吸暂停低通气综合征诊治指南(2011 年修订版)解读[J]. 中华结核和呼吸杂志, 2012, 35(1): 7-8. 李霞, 周智广, 亓海英, 等. 用空腹C肽代替胰岛素改良Homa公式评价胰岛素抵抗和胰岛β细胞功能[J]. 中南大学学报: 医学版, 2004, 29(4): 419-423. Xia M F, Bian H, Yan H M, et al. Assessment of liver fat content using quantitative ultrasonography to evaluate risks for metabolic diseases[J]. Obesity(Silver Spring), 2015, 23(9): 1929-1937.
Mahmood K, Akhter N, Eldeirawi K, et al. Prevalence of type 2 diabetes in patients with obstructive sleep apnea in a multi-ethnic sample[J]. J Clin Sleep Med, 2009, 5(3): 215-221.
Zhang P H, Zhang R, Zhao F, et al. The prevalence and characteristics of obstructive sleep apnea in hospitalized patients with type 2 diabetes in China[J]. J Sleep Res, 2016, 25(1): 39-46.
Balkau B, Vol S, Loko S, et al. High baseline insulin levels associated with 6-year incident observed sleep apnea[J]. Diabetes Care, 2010, 33(5): 1044-1049.
Hermans M P, Ahn S A, Mahadeb Y P, et al. Sleep apnoea syndrome and 10-year cardiovascular risk in females with type 2 diabetes: relationship with insulin secretion and insulin resistance[J]. Diabetes Metab Res Rev, 2013, 29(3): 227-234.
Barnett A H. New treatments in type 2 diabetes: a focus on the incretin-based therapies[J]. Clin Endocrinol(Oxf), 2009, 70(3): 343-353.
Drucker D J, Nauck M A. The incretin system: glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors in type 2 diabetes[J]. Lancet, 2006, 368(9548): 1696-1705.
Moreno J L, Willett K C, Desilets A R. Exenatide as a novel weight loss modality in patients without diabetes[J]. Ann Pharmacother, 2012, 46(12): 1700-1706.
Nadkarni P, Chepurny O G, Holz G G. Regulation of glucose homeostasis by GLP-1[J]. Prog Mol Biol Transl Sci, 2014, 121(121): 23-65.
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