Correlation Of Serum Inflammatory Factors,Vasoactive Substances,sCD36 And Type 2 Diabetes With Obstructive Sleep Apnea Syndrome

ObjectiveTo analyze the changes of the levels of inflammatory factors,vasoactive substances and soluble CD36?s CD36?in patients with type 2 diabetes?T2DM?combined with obstructive sleep apnea syndrome?OSAS?,and analyze their correlation with the severity of OSAS.MethodsAccording to the diagnostic criteria of the“guideline for the prevention and treatment of type 2 diabetes in China?2017 edition?”formulated by the diabetes branch of the Chinese medical association,a total of 219 T2DM patients who were hospitalized in Bozhou traditional Chinese medicine hospital of Anhui province from September2017 to September 2019 were selected using the convenient sampling method,of which61 were T2DM patients alone?T2DM group?,and 158 patients were combined with OSAS?combined group?.Another 60 patients with OSAS alone who were hospitalized in department of pulmonology of Bozhou traditional Chinese medicine hospital of Anhui province at the same time were selected according to the diagnostic criteria of the“diagnosis and treatment guidelines for obstructive sleep apnea hypopnea syndrome?2011 revision?”formulated by the sleep apnea group of the Chinese medical association respiratory branch,they were the OSAS group.There were no statistical differences in general clinical data such as gender,age,course of disease,and body mass index?BMI?among the three groups,comparable between groups.The levels of serum inflammatory factor suah as high-sensitivity C-reactive protein?hs-CRP?,interleukin-6?IL-6?,interleukin-8?IL-8?,intercellular adhesion molecule-l?ICAM-1?,tumor necrosis factor-??TNF-??were determined by enzyme-linked immunosorbent assay?ELISA?;the levels of vasoactive substances such as endothelin 1?ET-1?,thromboxane A2?TXA2?and nitric oxide?NO?in serum were measured by ELISA;the levels of s CD36 were measured by antibody sandwich ELISA;the glucose and lipid metabolism indexes and liver and kidney function indexes of patients were measured by a full-automatic biochemical analyzer;the sleep quality of patients was measured by a polysomnography monitor.The changes of the above-mentioned index levels of the three groups of patients were compared,and the multivariate logistic regression analysis was used to screen the risk factors of T2DM patients with OSAS.The patients were divided into non-OSAS group?n=61?,mild OSAS group?n=86?,moderate OSAS group?n=82?,and severe OSAS group?n=50?according to apnea hypopnea index?AHI?,the levels of inflammatory factors,vasoactive substances,s CD36 and sleep apnea index were compared between the four groups of patients,the multiple linear regression analysis was used to study the influencing factors of AHI in OSAS patients.Results?1?OSAS detection rate in T2DM patients?1?The detection rate of OSAS in the 219 T2DM patients selected in this study was72.15%,in which mild OSAS accounting for 43.04%,moderate OSAS accounting for35.44%,and severe OSAS accounting for 21.52%.?2?The detection rate of OSAS in T2DM patients with overweight or obese and poor glycemic control was significantly higher than that in T2DM patients with non-overweight or obese and good glycemic control,the difference was statistically significant?P<0.01?,and there was no significant difference in the detection rate of OSAS among T2DM patients with different genders,whether they were overweight or obese,whether they had metabolic syndrome and chronic complications?P>0.05?.?2?Comparison of the levels of inflammatory factors,vasoactive substances and s CD36in the patients of the T2DM group,the OSAS group and the combined group?1?The serum levels of hs-CRP,IL-6,IL-8,ICAM-1,TNF-?and s CD36 in the combined group were significantly higher than those in the T2DM group and the OSAS group?P<0.01?.?2?The serum levels of ET-1 and TXA2 in the combined group were significantly higher than those in the T2DM group and the OSAS group,the level of NO was significantly lower than that of the T2DM group and the OSAS group?P<0.01?.?3?The levels of fasting blood glucose?FBG?,glycated hemoglobin?Hb A1c?and homeostasis model insulin resistance index?HOMA-IR?in the combined group were significantly higher than those in the T2DM group and the OSAS group?P<0.05 or P<0.01?,the 2 h postprandial blood glucose?2h PBG?levels in the combined group were significantly higher than those in the T2DM group?P<0.01?.?4?There was no significant difference in the serum levels of total bilirubin?TBil?,triglyceride?TG?,cholesterol?TC?,high density lipoprotein cholesterol?HDL-C?,low density lipoprotein cholesterol?LDL-C?,creatinine?Scr?and blood urea nitrogen?BUN?in the 3 groups?P>0.05?.?5?Multivariate Logistic regression analysis showed that the BMI,waist-to-hip ratio,levels of ICAM-1,TXA2,s CD36 and Hb A1c were independent risk factor for OSAS in T2DM patients?P<0.05?,and NO level was independent protective factor for OSAS in T2DM patients?P<0.05?.?6?The sleep latency and sleep time of the combined group were significantly shorter than those of the T2DM group,the snoring index was significantly higher than that of the T2DM group?P<0.01?,the sleep efficiency and minimum blood oxygen saturation(Sa O_2min)of the combined group were significantly lower than those of the T2DM group and OSAS group,AHI was significantly higher than those of the T2DM group and OSAS group?P<0.01?.?3?Comparison of the levels of inflammatory factors,vasoactive substances and s CD36in patients with different degrees of OSAS classification?1?The levels of serum hs-CRP,IL-6,IL-8,ICAM-1,TNF-?,s CD36 and ET-1,TXA2 gradually increased,the level of NO gradually decreased in the four groups of patients with non-OSAS group,mild OSAS group,moderate OSAS group and severe OSAS group?P<0.05 or P<0.01?.?2?The sleep latency and sleep time of patients gradually shortened,the sleep efficiency and Sa O_2mingradually decreased,the AHI and snoring index gradually increased in the four groups of patients with non-OSAS group,mild OSAS group,moderate OSAS group and severe OSAS group?P<0.01?.?4?Influencing factors of the degree of sleep apnea obstacleMultiple linear regression analysis showed that the duration of diabetes,ICAM-1,TNF-?,TXA2,NO,s CD36 and Hb A1c were influencing factor of AHI in OSAS patient?P<0.05?.Conclusion?1?The detection rate of OSAS is higher in T2DM patients.?2?Inflammatory factors,vasoactive substances and s CD36 are involved in the occurrence and development of T2DM combined with OSAS.?3?OSAS patients have obvious sleep structural disorders and respiratory dysfunction,the more severe the OSAS,the more obvious the patients'sleep structural disorders and respiratory dysfunction.