[1]傅宇哲,冯文焕,张宁静,等.阻塞性睡眠呼吸暂停综合征对肥胖患者非酒精性脂肪性肝病严重程度的影响[J].国际内分泌代谢杂志,2022,42(06):505-509.[doi:10.3760/cma.j.cn121383-20211019-10042]
　Fu Yuzhe,Feng Wenhuan,Zhang Ningjing,et al.Effect of obstructive sleep apnea syndrome on the severity of nonalcoholic fatty liver disease in patients with obesity[J].International Journal of Endocrinology and Metabolism,2022,42(06):505-509.[doi:10.3760/cma.j.cn121383-20211019-10042]
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阻塞性睡眠呼吸暂停综合征对肥胖患者非酒精性脂肪性肝病严重程度的影响()
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《国际内分泌代谢杂志》[ISSN:1673-4157/CN:12-1383/R]

卷:
42
期数:
2022年06期
页码:
505-509
栏目:
论著
出版日期:
2022-11-20

文章信息/Info

Title:
Effect of obstructive sleep apnea syndrome on the severity of nonalcoholic fatty liver disease in patients with obesity
作者:
傅宇哲1; 冯文焕1; 张宁静1; 孙喜太2; 毕艳1
1南京医科大学鼓楼临床医学院内分泌科 210008; 2南京大学附属鼓楼医院普外科 210008
Author(s):
Fu Yuzhe1;  Feng Wenhuan1;  Zhang Ningjing1;  Sun Xitai2;  Bi Yan1.
1Department of Endocrinology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing 210008, China; 2Deprtment of General Surgery, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing 210008, China
关键词:
非酒精性脂肪性肝病;  阻塞性睡眠呼吸暂停综合征;  慢性间歇性缺氧
Keywords:
Nonalcoholic fatty liver disease;  Obstructive sleep apnea syndrome;  Chronic intermittent hypoxia
DOI:
10.3760/cma.j.cn121383-20211019-10042
摘要:
目的 探究阻塞性睡眠呼吸暂停综合征(OSA)对肥胖患者非酒精性脂肪肝病(NAFLD)严重程度的影响。方法 选取自2019年10月至2021年2月南京大学医学院附属鼓楼医院内分泌科住院并经肝脏穿刺活检诊断NAFLD的肥胖患者144例(OSA组,70例; 非OSA组74例)。比较两组血清肝酶、肝脏病理结果等,并分析其影响结果。结果 与非OSA组相比,OSA组转氨酶、小叶炎症严重程度、NAFLD活动性评分更高(P均<0.05),非酒精性脂肪性肝炎(NASH)患病比例更高(P<0.05)。相关分析显示,NAFLD活动性评分与呼吸暂停低通气指数(AHI)、氧减指数(ODI)呈正相关,与平均血氧饱和度(SaO2)、最低SaO2呈负相关; 肝脂肪变与AHI、ODI呈正相关; 气球样变与AHI、ODI呈正相关; 小叶炎症与AHI、ODI呈正相关,与平均SaO2、最低SaO2呈负相关。多因素logistic回归分析显示,OSA是NASH的独立危险因素(OR=8.397, 95% CI: 2.504～28.160)。结论 OSA引起的慢性间歇性缺氧是肥胖患者NASH发病的重要危险因素。
Abstract:
Objective To explore the influence of obstructive sleep apnea syndrome(OSA)on the severity of nonalcoholic fatty liver disease(NAFLD)in obese patients.Methods A total of 144 obese patients(OSA group,70 cases; non-OSA group, 74 cases)who were hospitalized in the Department of Endocrinology, Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School and biopsy-proven NAFLD from October 2019 to February 2021 were enrolled in this study. The serum liver enzymes and liver pathology of the two groups were compared, and the influence results were analyzed.Results Compared with the non-OSA group, the OSA group had higher serum levels of liver enzymes, severity of lobular inflammation, and NAFLD activity score(all P<0.05), and a higher prevalence of nonalcoholic steatohepatitis(NASH)(P<0.05). The results showed that NAFLD activity score was positively correlated with apnea-hypopnea index(AHI)and oxygen desaturation index(ODI), and negatively correlated with mean and minimum oxygen saturation(SaO2); hepatic steatosis was also positively associated with AHI and ODI; so was between the hepatocytes ballooning and AHI and ODI; the lobular inflammation was positively correlated with AHI and ODI, but negatively correlated with mean and lowest SaO2. Multivariate logistic regression analysis showed that OSA was an independent risk factor for NASH(OR=8.397, 95% CI: 2.504～28.160).Conclusion Chronic intermittent hypoxia caused by OSA is a crucial risk factor for NASH in obese patients.

参考文献/References:

[1] Sheka AC,Adeyi O,Thompson J,et al.Nonalcoholic steatohepatitis:a review [J].JAMA,2020,323(12):1175-1183.DOI:10.1001/jama.2020.2298.
[2] Umbro I,Fabiani V,Fabiani M,et al.Association between non-alcoholic fatty liver disease and obstructive sleep apnea [J].World J Gastroenterol,2020,26(20):2669-2681.DOI:10.3748/wjg.v26.i20.2669.
[3] Mesarwi OA,Loomba R,Malhotra A.Obstructive sleep apnea,hypoxia,and nonalcoholic fatty liver disease [J].Am J Respir Crit Care Med,2019,199(7):830-841.DOI:10.1164/rccm.201806-1109TR.
[4] Kleiner DE,Brunt EM,Van Natta M,et al.Design and validation of a histological scoring system for nonalcoholic fatty liver disease [J].Hepatology,2005,41(6):1313-1321.DOI:10.1002/hep.20701.
[5] 何权瀛,王莞尔.阻塞性睡眠呼吸暂停低通气综合征诊治指南(基层版)[J].中国呼吸与危重监护杂志,2015,14(4):398-405.DOI:10.7507/1671-6205.2015100.
[6] Tang Q,Li X,Song P,et al.Optimal cut-off values for the homeostasis model assessment of insulin resistance(HOMA-IR)and pre-diabetes screening:developments in research and prospects for the future [J].Drug Discov Ther,2015,9(6):380-385.DOI:10.5582/ddt.2015.01207.
[7] Fan JG,Kim SU,Wong VW.New trends on obesity and NAFLD in Asia [J].J Hepatol,2017,67(4):862-873.DOI:10.1016/j.jhep.2017.06.003.
[8] Trzepizur W,Boursier J,Le Vaillant M,et al.Increased liver stiffness in patients with severe sleep apnoea and metabolic comorbidities [J].Eur Respir J,2018,51(6):1800601.DOI:10.1183/13993003.00601-2018.
[9] Trzepizur W,Boursier J,Mansour Y,et al.Association between severity of obstructive sleep apnea and blood markers of liver injury [J].Clin Gastroenterol Hepatol,2016,14(11):1657-1661.DOI:10.1016/j.cgh.2016.04.037.
[10] Agrawal S,Duseja A,Aggarwal A,et al.Obstructive sleep apnea is an important predictor of hepatic fibrosis in patients with nonalcoholic fatty liver disease in a tertiary care center [J].Hepatol Int,2015,9(2):283-291.DOI:10.1007/s12072-015-9615-3.
[11] Aron-Wisnewsky J,Minville C,Tordjman J,et al.Chronic intermittent hypoxia is a major trigger for non-alcoholic fatty liver disease in morbid obese [J].J Hepatol,2012,56(1):225-233.DOI:10.1016/j.jhep.2011.04.022.
[12] Benotti P,Wood GC,Argyropoulos G,et al.The impact of obstructive sleep apnea on nonalcoholic fatty liver disease in patients with severe obesity [J].Obesity(Silver Spring),2016,24(4):871-877.DOI:10.1002/oby.21409.
[13] Schwenger KJP,Ghorbani Y,Li C,et al.Obstructive sleep apnea and non-alcoholic fatty liver disease in obese patients undergoing bariatric surgery [J].Obes Surg,2020,30(7):2572-2578.DOI:10.1007/s11695-020-04514-3.
[14] Tanné F,Gagnadoux F,Chazouillères O,et al.Chronic liver injury during obstructive sleep apnea [J].Hepatology,2005,41(6):1290-1296.DOI:10.1002/hep.20725.
[15] Zhang L,Zhang X,Meng H,et al.Obstructive sleep apnea and liver injury in severely obese patients with nonalcoholic fatty liver disease [J].Sleep Breath,2020,24(4):1515-1521.DOI:10.1007/s11325-020-02018-z.
[16] Ryan S,Arnaud C,Fitzpatrick SF,et al.Adipose tissue as a key player in obstructive sleep apnoea [J].Eur Respir Rev,2019,28(152):190006.DOI:10.1183/16000617.0006-2019.
[17] Sherwani SI,Aldana C,Usmani S,et al.Intermittent hypoxia exacerbates pancreatic β-cell dysfunction in a mouse model of diabetes mellitus [J].Sleep,2013,36(12):1849-1858.DOI:10.5665/sleep.3214.
[18] Savransky V,Bevans S,Nanayakkara A,et al.Chronic intermittent hypoxia causes hepatitis in a mouse model of diet-induced fatty liver [J].Am J Physiol Gastrointest Liver Physiol,2007,293(4):G871-877.DOI:10.1152/ajpgi.00145.2007.
[19] Kumar D,Dwivedi DK,Lahkar M,et al.Hepatoprotective potential of 7,8-Dihydroxyflavone against alcohol and high-fat diet induced liver toxicity via attenuation of oxido-nitrosative stress and NF-κB activation [J].Pharmacol Rep,2019,71(6):1235-1243.DOI:10.1016/j.pharep.2019.07.002.
[20] Qu A,Taylor M,Xue X,et al.Hypoxia-inducible transcription factor 2α promotes steatohepatitis through augmenting lipid accumulation,inflammation,and fibrosis [J].Hepatology,2011,54(2):472-483.DOI:10.1002/hep.24400.
[21] Wang X,de Carvalho Ribeiro M,Iracheta-Vellve A,et al.Macrophage-specific hypoxia-inducible factor-1α contributes to impaired autophagic flux in nonalcoholic steatohepatitis [J].Hepatology,2019,69(2):545-563.DOI:10.1002/hep.30215.
[22] Parikh MP,Gupta NM,McCullough AJ.Obstructive sleep apnea and the liver [J].Clin Liver Dis,2019,23(2):363-382.DOI:10.1016/j.cld.2019.01.001.
[23] Doulberis,M.Kotronis G,Gialamprinou D,et al.Non-alcoholic fatty liver disease:an update with special focus on the role of gut microbiota [J].Metabolism,2017,71:182-197.DOI:10.1016/j.metabol.2017.03.013.

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备注/Memo

备注/Memo:
通信作者:毕艳, Email: biyan@nju.edu.cn
基金项目:国家自然科学基金资助项目(82030026); 江苏省自然科学基金面上项目(BK20201115); 南京市卫生科技发展专项资金项目(YKK18067)
更新日期/Last Update: 2022-12-01