CPAP对2型糖尿病合并OSAHS患者的临床疗效观察(1)
摘要 目的：观察和评估2型糖尿病合并阻塞性睡眠呼吸暂停低通气综合征(Obstructive Sleep Apnea Hypopnea Syndrom，OSAHS)患者使用持续气道正压通气(Coutinuous Positive Airway Pressure，CPAP)治疗16周后临床疗效的变化。方法：选取2012年1月至2017年6月于煤炭总医院内分泌科确诊2型糖尿病患者合并有OSAHS的患者60例，按1∶1的比例随机分配到实验组A组(降糖药物联合无创呼吸机)、对照组B组(单纯使用降糖药物)，每组30例。降糖治疗方式不限。并根据血糖检测值来调整降糖治疗方案。若有其他伴随疾病的用药，按原方案继续使用。睡眠监测采用便携式瑞思迈多导睡眠监测仪，型号：YH-1000，呼吸机采用瑞思邁ESCAPAUTO自动调压单水平呼吸机。呼吸机每日佩戴不少于6 h，随访16周。比较2组患者空腹血糖(Fasting Blood-glucose，FPG)、餐后2 h血糖(2-hour Postprandial Blood Sugar，2 h PPG)、胰岛素抵抗指数(HOMA-IR)、胰岛β细胞功能HOME-β、糖化血红蛋白(HbA1c)达标的时间以及血脂四项、呼吸暂停低通气指数(Apnea-hypopnea Index，AHI)、最低脉搏容积血氧饱和度(LSpO2%)、生命质量及对治疗满意度提高等变化情况。结果：2组患者血糖均得到良好控制(A组的血糖控制情况较B组更好)、糖化血红蛋白(HbA1c)、血脂四项2组没有统计学差异(P>0.05);A组胰岛素抵抗指数(HOMA-IR)较B组降低(P<0.001);A组的胰岛素功能指数(HOMA-β)、AHI、LSpO2%较B组有改善(P<0.001);A组HbA1c达标所需时间比B组短、问卷调查患者的生命质量及对治疗的满意度提高(P<0.05)。结论：2型糖尿病合并OSAHS患者进行CPAP治疗是有效、安全、简便、可行的。可以改善胰岛素抵抗，恢复胰岛细胞功能，缩短血糖达标所需时间，可以提高患者的生命质量及对治疗的满意度。
关键词 OSAHS;2型糖尿病;CPAP;胰岛素抵抗
Abstract Objective：To observe and evaluate the clinical efficacy of patients with type 2 diabetes complicated with Obstructive Sleep Apnea-Hypopnea Syndrome(OSAHS)treated with continuous positive airway pressure(CPAP)for 16 weeks.Methods：Sixty patients with type 2 diabetes and OSAHS who had been diagnosed in the Department of Endocrinology in China Meitan General Hospital from January 2012 to June 2017 were randomly selected and randomly assigned to the experimental group A(hypoglycemic drugs combined with non-invasive ventilator)and control group B(hypoglycemic drugs).The rate is 1∶1，which means 30 cases in each group.There is no limit to the way of reducing blood sugar.The hypoglycemic treatment plan is to adjust according to the blood glucose detection value.If there are other medications associated with the disease，continue to use the original program.The sleep monitoring is a portable ResMed polysomnography monitor，model YH-1000，and the ventilator is a ResMed ESCAPAUTO self-regulating single-level ventilator.The ventilator is worn no less than 6 hours a day for 16 weeks.The fasting blood glucose(FPG)，postprandial blood glucose(2-hour PPG)，insulin resistance index(HOMA-IR)，islet β-cell function(HOME-β)，glycated hemoglobin(HbA1c)，four items of blood lipids，apnea-hypopnea index(AHI)，minimum pulse volume oxygen saturation(LSpO2%)，quality of life，and satisfaction with treatment were compared between the two groups.Results：The blood glucose levels of the two groups were well controlled(the blood glucose of group A was better than that of group B).The glycosylated hemoglobin(HbA1c)，and the four items of blood lipids were not statistically different(P>0.05).The insulin resistance index(HOMA-IR)of group Awas lower than that of group B(P<0.001); insulin function index(HOMA-β)，AHI，and LSpO2% of group A were improved compared with group B(P<0.001); the time required for HbA1c to reach the standard of group A was shorter than that of group B.The quality of life and satisfaction with treatment increased(P<0.05)of group A was higher than that of group B according to the patient′s survey.Conclusion：The CPAP treatment for patients with type 2 diabetes complicated with OSAHS is effective，safe，feasible and straightforward.It can improve insulin resistance，restore islet cell function，shorten the time required for blood glucose to reach the standard，and improve the patient′s quality of life and satisfaction with treatment., http://www.100md.com(李洪梅 韩旸 王凯亮)
关键词 OSAHS;2型糖尿病;CPAP;胰岛素抵抗
Abstract Objective：To observe and evaluate the clinical efficacy of patients with type 2 diabetes complicated with Obstructive Sleep Apnea-Hypopnea Syndrome(OSAHS)treated with continuous positive airway pressure(CPAP)for 16 weeks.Methods：Sixty patients with type 2 diabetes and OSAHS who had been diagnosed in the Department of Endocrinology in China Meitan General Hospital from January 2012 to June 2017 were randomly selected and randomly assigned to the experimental group A(hypoglycemic drugs combined with non-invasive ventilator)and control group B(hypoglycemic drugs).The rate is 1∶1，which means 30 cases in each group.There is no limit to the way of reducing blood sugar.The hypoglycemic treatment plan is to adjust according to the blood glucose detection value.If there are other medications associated with the disease，continue to use the original program.The sleep monitoring is a portable ResMed polysomnography monitor，model YH-1000，and the ventilator is a ResMed ESCAPAUTO self-regulating single-level ventilator.The ventilator is worn no less than 6 hours a day for 16 weeks.The fasting blood glucose(FPG)，postprandial blood glucose(2-hour PPG)，insulin resistance index(HOMA-IR)，islet β-cell function(HOME-β)，glycated hemoglobin(HbA1c)，four items of blood lipids，apnea-hypopnea index(AHI)，minimum pulse volume oxygen saturation(LSpO2%)，quality of life，and satisfaction with treatment were compared between the two groups.Results：The blood glucose levels of the two groups were well controlled(the blood glucose of group A was better than that of group B).The glycosylated hemoglobin(HbA1c)，and the four items of blood lipids were not statistically different(P>0.05).The insulin resistance index(HOMA-IR)of group Awas lower than that of group B(P<0.001); insulin function index(HOMA-β)，AHI，and LSpO2% of group A were improved compared with group B(P<0.001); the time required for HbA1c to reach the standard of group A was shorter than that of group B.The quality of life and satisfaction with treatment increased(P<0.05)of group A was higher than that of group B according to the patient′s survey.Conclusion：The CPAP treatment for patients with type 2 diabetes complicated with OSAHS is effective，safe，feasible and straightforward.It can improve insulin resistance，restore islet cell function，shorten the time required for blood glucose to reach the standard，and improve the patient′s quality of life and satisfaction with treatment., http://www.100md.com(李洪梅 韩旸 王凯亮)