青海地区不同程度OSA对NAFLD血脂代谢的影响研究

钱 明学, 久 太*
青海大学附属医院

摘要


本综述主要聚焦于阻塞性睡眠呼吸暂停（Obstructive Sleep Apnea，OSA）与非酒精性脂肪肝（Non-alcoholic Fatty Liver Disease，NAFLD）之间的关联，着重探讨OSA对NAFLD患者血脂代谢的影响。阻塞性睡眠呼吸暂停（OSA）是一种发病率很高的且与睡眠相关联的呼吸障碍性疾病[1]，OSA是由于在睡眠期间咽部肌肉张力下降从而导致咽部坍陷，进而引起反复的上呼吸道部分或完全阻塞，导致睡眠碎片化和反复出现氧合血红蛋白饱和度降低，称为慢性间歇性缺氧[2]，其特征是睡眠期间由于上气道反复狭窄和关闭，导致至少10秒的短暂呼吸停止或潮气量显著减少，进而引起慢性间歇性缺氧（CIH）和交感神经激活[3]，同时伴有频繁的微觉醒。OSA最常见的症状是白天过度嗜睡、睡眠不规律、打鼾、疲劳和认知功能受损[4]，由于睡眠中反复发作的上呼吸道阻塞，间歇性缺氧-复氧和睡眠碎片可能会导致全身各脏器缺氧，而对低氧敏感的肝组织缺氧将引起肝内代谢紊乱、功能异常，尤其是脂质代谢紊乱、肝功能异常，OSA越来越被认为是一种多系统疾病，因为它与多种不良健康结果有关，包括心血管系统疾病和代谢疾病[5]。OSA的严重程度使用AHI进行评估，分为轻度（5-14.9）、中度（15-29.9）和重度（≥30）[6]。而非酒精性脂肪肝（NAFLD）则是指除外酒精和其他明确的肝损伤因素所致的、以肝细胞脂肪变性为主要特征的临床病理综合征，非酒精性脂肪肝（NAFLD）是一种慢性肝病，其特征是>5%的肝细胞中积聚了脂滴[7]。近年来发现，阻塞性睡眠呼吸暂停（OSA）可能与非酒精性脂肪肝（NAFLD）的发病机制和严重程度有关，鉴于肥胖与胰岛素抵抗（IR）之间众所周知的关联，同时可以推测得出OSA严重程度与IR程度之间可能存在关联[8]。IR也被认为与NAFLD有关，更重要的是，IR与NAFLD的发病机制和从脂肪变性到NASH的进展有关[9]。因此，NAFLD和OSA之间应该存在关联。最近的研究提供了证据，表明OSA和慢性间歇性缺氧（CIH）是NAFLD的危险因素[10]，随着OSA和NAFLD的患病率急剧上升，这些疾病对人类健康产生了显著的不利影响，这些患者的医疗费用也随之增加。不幸的是，迄今为止，还没有针对OSA合并NAFLD的有效治疗策略，深入研究二者关系对疾病的防治具有重要意义。

关键词


阻塞性睡眠呼吸暂停；非酒精性脂肪肝；血脂代谢

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参考


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