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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