单位：[1]Department of Pulmonary and Critical Care Medicine, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China[2]Center for Respiratory Diseases, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Beijing 100029, China[3]Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China[4]The Graduate School of Peking Union Medical College, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China[5]Capital Medical University, Beijing, China[6]Peking University Health Science Center, Beijing, China[7]Department of General Surgery, China-Japan Friendship Hospital, Beijing 100029, China
Objectives Obstructive sleep apnea (OSA) and nonalcoholic fatty liver disease (NAFLD) are common in subjects with severe obesity. It has been suggested that insulin resistance and systemic inflammation may play a role in the development of nonalcoholic steatohepatitis (NASH), but the mechanisms remain controversial. The aim of this study was to explore the influence of OSA on liver injury and its potential mechanisms in severely obese patients with NAFLD. Methods Severely obese patients requiring bariatric surgery were consecutively recruited between November 2017 and June 2018. Demographic, biochemical, liver ultrasound, and ambulatory polygraph data were collected. Results One hundred fifty-three subjects with liver ultrasound-verified NAFLD were classified into three groups according to the apnea-hypopnea index (AHI). The level of serum alanine aminotransferase (ALT) and gamma-glutamyl transpeptidase (GGT) tended to increase with more severe OSA (P = 0.024 and P = 0.004, respectively). In the unadjusted analysis, both ALT and GGT were positively correlated with AHI, oxygen desaturation index, percentage of total sleep time spent with oxyhemoglobin saturation below 90%, male sex, homeostasis model assessment of insulin resistance (HOMA-IR), and total cholesterol, while liver enzymes were negatively related to lowest oxygen saturation. In multiple regression analysis, AHI (odds ratio (OR) = 1.052, P = 0.044) and HOMA-IR (OR = 1.135, P = 0.001) were independent risk factors for an elevated ALT level. High-sensitivity C-reactive protein (hs-CRP) was positively associated with BMI and GGT (r = 0.349 and r = 0.164 (P < 0.05), respectively), and no correlation was found between hs-CRP and AHI or other parameters of hypoxia. hs-CRP and GGT remained significantly correlated after adjusting for confounding parameters (OR = 2.509, P = 0.013). Conclusions OSA may play a role in liver injury among severely obese individuals with NAFLD. Insulin resistance and systemic inflammation were possible contributing factors in this process.
基金：
Precision Medicine Project [2016YFC0903602]; National Key Research and Development Project [2016YFC1304500]; Ministry of Science and Technology of ChinaMinistry of Science and Technology, China
第一作者单位：[1]Department of Pulmonary and Critical Care Medicine, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China[2]Center for Respiratory Diseases, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Beijing 100029, China
共同第一作者：
通讯作者：
通讯机构：[1]Department of Pulmonary and Critical Care Medicine, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China[2]Center for Respiratory Diseases, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Beijing 100029, China[3]Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China[4]The Graduate School of Peking Union Medical College, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China[5]Capital Medical University, Beijing, China[6]Peking University Health Science Center, Beijing, China
推荐引用方式(GB/T 7714)：
Zhang Li,Zhang Xiaolei,Meng Hua,et al.Obstructive sleep apnea and liver injury in severely obese patients with nonalcoholic fatty liver disease[J].SLEEP and BREATHING.2020,24(4):1515-1521.doi:10.1007/s11325-020-02018-z.
APA：
Zhang, Li,Zhang, Xiaolei,Meng, Hua,Li, Yiming,Han, Teng&Wang, Chen.(2020).Obstructive sleep apnea and liver injury in severely obese patients with nonalcoholic fatty liver disease.SLEEP and BREATHING,24,(4)
MLA：
Zhang, Li,et al."Obstructive sleep apnea and liver injury in severely obese patients with nonalcoholic fatty liver disease".SLEEP and BREATHING 24..4(2020):1515-1521
