| Obstructive sleep apnea syndrome (OSAS) is a potentially dangerous sleep relatedbreathing disorder,which apnea, hypopnea often occurs in sleep and causeshyoxemia,hypercarbia,acidaemia and other pathophysiological changes. With increase of obesepopulation, the number of patiemts with OSAS rises rapidly, and OSAS patients combined withdiabetes,cardiovascular disease and cerebrovascular disease increases obviously. Recently someresearchers regarded OSAS as a part of metabolic syndrome (MS) which insulin resistance is thecentral component.Nearly10years of research found that fat factor play an important role in thepathogenesis of insulin resistance,which are linked to obesity, diabetes and its complications.Apelin is lonely G protein coupling receptor endogenous ligand of angiotensin receptor AT1related receptor proteins (oGPCR APJ). Apelin/APJ system widely distributed in the heart, lungs,kidneys, vascular system, central nervous system, adipose organization and so on. Recent studieshave found that it is a kind of new fat cell factor, related with obesity and insulin resistance, butthe specific mechanism has not yet fully understood. therefore, Apelin/APJ system may beinvolved in the OSAS and chronic complications development. But little is known about therelationship between serum apelin level and insulin resistance in patients with OSAS.In thisstudy,we observed fasting blood glucose (FBG) levels,fasting insulin (FINS) and fasting apelinlevels in these cases, in order to explore the relationship between apelin and insulin resistance inpatients with OSAS by compartial relationship analyze.Part one Relationship of apelin and insulin resistance in OSAS and obese patientsMethods Polysomnography were performed in all cases.These cases were divided into fourgroups by BMI and AHI: groups A obese OSAS(BMI27,AHI5),groups B non obeseOSAS(BMI<25,AHI5),groups C simple obese(BMI27,AHI<5) groups D normalcontrol(BMI<25,AHI<5).FBG levels were measured by glueose oxidase FINS were measuredby radio immunoassay,apelin were measured by ELISA,Homeostasis model assessment insulinresistance(HOMA IR) were calculated according to FBG and FINS level in these cases.Therelationship between apelin level and insulin resistance in patients with OSAS was analyzed bycompartial relationship analyze.Results (l) The FBG levels of group A, B, C and D were:5.60±0.26mmol/l,5.75±0.37mmol/l,5.67±0.30mmol/l and5.21±0.46mmol/l, FINS are:16.61±1.93mU/l,11.36±1.53mU/l,11.17±1.71mU/l and9.13±l.07mU/l. Compared with D Group, the FINS and FBG levels of group A, B and C were significantly higher (P <0.05~0.01); Three groups ofcomparison between FBG no significant difference (P>0.05), and A group of FINS verysignificantly higher than group B and C (P <0.01).(2) The apelin of four groups are:424.9±20.9ng/L,379.5±25.3ng/L,389.4±18.3ng/L and360.3±15.4ng/L; the apelin of A, B and C aresignificantly higher compared with D(P <0.05~0.01), and A group of apelin very significantlyhigher than B and C group (P <0.01).(3)The ln(HOMA IR) of four groups are:1.41±0.17,1.05±0.15,1.02±0.20and0.74±0.13;the HOMA IR of A, B and C group increased significantlycompared with D(P <0.05), and group A significantly higher than C group (P <0.05).(4)multivariable analysis showed that the serum apelin of OSAS patients were positively correlatedwith FINS, ln(HOMA IR),the coefficients were0.404(p <0.01) and0.759(p <0.01).Part two Relationship of apelin and insulin resistance in different degree OSASMethods Polysomnography were performed in all cases.These cases were divided intothree groups by AHI of OSAS: group A middle and severe OSAS(AHI20) group B mildOSAS(AHI5~20),group C normal control (AHI<5).FBG levels were measured byglueose oxidase FINS were measured by radio immunoassay,apelin were measured byELISA,HOMA IR and FBCI were calculated according to FBG and FINS level in thesecases.The relationship between apelin level and insulin resistance in patients with OSAS wasanalyzed by compartial relationship analyze.Results (1) The FBG of A, B and C group respectively were:5.64±0.38mmol/L,5.60±0.54mmol/L and5.16±0.59mmol/L, and A and B group were significantly higher in FBGcompared with group C(P <0.05), but between two groups there is no significant difference (P>0.05); Three groups of FINS were:16.36±3.14mU/L,11.42±l.85mU/L and8.95±l.56mU/L;Compared with the group C, the FINS of A and B group were very significantly higher (P <0.01),and the FINS of A group also was very significantly higher than B group (P <0.01).(2) threegroups apelin were:426.3±35.0ng/L,392.2±31.1ng/L and360.2±23.4ng/L, and comparedwith group C, the apelin of A and B group were significantly higher (P <0.01), and the apelinof A group also was very significantly higher than B group (P <0.01).(3) The HOMA IR ofthree groups were:4.12±0.94,2.84±0.56and2.07±0.53, respectively FBCI was:2.90±0.51and2.06±0.38and1.72±0.24, and compared with group C, the HOMA IR and FBCI of A and Bgroup were significantly higher (P <0.05~0.01), and the HOMA IR and FBCI of A group weresignificantly higher than B group (P <0.01);(4) The apelin of OSAS patients had a positivecorrelation with BMI, FINS, HOMA IR and FBCI, the relevant coefficients were:0.4994(P <0.01), and0.3336(P <0.05), and0.5790(P <0.01) and0.5771(P <0.01).Conclusions1.Obesity can lead to apelin serum level rising, OSAS can lead to further raise of apelin of obese patients.2.The apelin serum level of OSAS patients is increasedsignificantly than obese and normal, and along with the illness, apelin serum level further raise.3.The serum insulin level and HOMA insulin sensitivity index of OSAS patients increaseobviously higher than fat person and normal person,and with the increase in OSAS condition, theinsulin resistance is more obvious.4.The apelin serum level of OSAS patients may havesomething with the insulin resistance. |
PDF Full Text Request