廖斌 李强翔 周艳 周洪 李文静 彭友 李华桦

【摘要】 目的 探讨睡眠剥夺对2型糖尿病患者糖脂代谢、炎性因子及褪黑素（MT）含量的影响。

方法 选取2019年1月～2020年10月150例2型糖尿病患者设为研究组，根据睡眠剥夺情况分为正常睡眠组、轻度睡眠剥夺组、重度睡眠剥夺组，各50例，另选取同期50名健康体检者设为健康对照组。抽取各组血液样本，测定血清炎性因子[白细胞介素6（IL6）、肿瘤坏死因子α（TNFα）]、内皮素1（ET1）、MT水平、血脂[高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、总胆固醇（TC）、甘油三酯（TG）]、血糖[糖化血红蛋白（HbA1c）、空腹血糖（FPG）、餐后2 h血糖（2 hPG）]水平，并对轻度睡眠剥夺组、重度睡眠剥夺组患者进行睡眠时间纠正。

结果 研究组IL6、TNFα、LDL、TC、TG、HbA1c、FPG、2 hPG、ET1水平高于健康对照组，HDL、MT水平低于健康对照组（P<0.001）;轻度睡眠剥夺组IL6、TNFα、LDL、TC、TG、HbA1c、FPG、2 hPG、ET1水平高于正常睡眠组，HDL、MT水平低于正常睡眠组（P<0.05）;重度睡眠剥夺组IL6、TNFα、LDL、TC、TG、HbA1c、FPG、2 hPG、ET1水平高于轻度睡眠剥夺组，HDL、MT水平低于轻度睡眠剥夺组（P<0.05）。睡眠时间纠正后轻度睡眠剥夺组、重度睡眠剥夺组IL6、TNFα、LDL、TC、TG、HbA1c、FPG、2 hPG、ET1、HDL、MT水平较干预前改善（P<0.001），組间比较差异无统计学意义（P>0.05）。

结论 2型糖尿病患者存在糖脂代谢紊乱及不同程度炎性反应，而睡眠剥夺可影响2型糖尿病患者糖脂代谢状态，加剧炎性反应程度，降低MT含量，纠正睡眠时间后可有效逆转上述现象。

【关键词】 睡眠剥夺;2型糖尿病;糖脂代谢;炎性因子;褪黑素

中图分类号：R587. 文献标志码： DOI：10.3969/j.issn.10031383.2021.06.005

Effects of sleep deprivation on glucose and lipid metabolism， inflammatory factors and melatonin in patients with type 2 diabetes mellitus

LIAO Bin1，3， LI Qiangxiang2，3▲， ZHOU Yan1， ZHOU Hong1， LI Wenjing1， PENG You1， LI Huahua1

（1. Department of Geriatrics， The People's Hospital of Hunan Province， Changsh410016， Hunan， China; 2. The Geriatrics Institute of Hunan Province， Changsha 410016， Hunan， China; 3. Clinical Research Center oGeriatric Diseases， Yinchuan 750001， Ningxia， China）

【Abstract】 Objective To investigate the effects of sleep deprivation on glucose and lipid metabolism， inflammatory factors and melatonin （MT） in patients with type 2 diabetes mellitus.

Methods 150 patients with type 2 diabetes mellitus in our hospital from January 2019 to October 2020 were selected as study group， and they werdivided into normal sleep group， mild sleep deprivation group and severe sleep deprivation group according to the sleep deprivation situation， with 50 cases in each group. Another 50 healthy people in the same period were selected as healthy control group. Blood samples were collected from each group to detect the levels of inflammatory factors （interleukin[IL6]tumor necrosis factorα [TNFα]）， endothelin1 （ET1）， MT， blood lipids （high density lipoprotein [HDL]， low density lipoprotein [LDL]， total cholesterol [TC]， triglyceride [TG]）， and blood glucose （glycosylated hemoglobin [HbA1c]fasting plasma glucose [FPG]， 2 h postprandial blood glucose [2 hPG]）. And the sleep time of patients in the mild sleep deprivation group and the severe sleep deprivation group was corrected.

Results The IL6， TNFα， LDL， TC， TG， HbA1c， FPG， 2 hPG， ET1 levels in thstudy group werhigher than those in thhealthy control group， while the HDL and MT levels were lower than those in the healthy control group （P < 0.001）The levels of IL6， TNFα， LDL， TC， TG， HbA1c， FPG， 2 hPG and ET1 in the mild sleep deprivation group were higher than those in the normal sleep group， while the levels of HDL and MT were lower than those in the normal sleep group （P < 0.05）. The levels of IL6， TNFα， LDL， TC， TG， HbA1c， FPG， 2 hPG and ET1 in the severe sleep deprivation group were higher than those in the mild sleep deprivation group， while the levels of HDL and MT were lower than those in the mild sleep deprivation group （P < 0.05）. After sleep time correction， the levels of IL6， TNFα， LDL， TC， TG， HbA1c， FPG， 2 hPG， ET1， HDL and MT among the mild sleep deprivation group and the severe sleep deprivation group significantly improved while comparing while those before sleep time correction （P < 0.001）， but difference between groups was not statistically significant （P > 0.05）.

Conclusion Patients with type 2 diabetes mellitus have glucose and lipid metabolism disorder and different degrees of inflammatory reaction. Sleep deprivation can affect the glucose and lipid metabolism of them， aggravate the degree of inflammatory reaction， reduce the content of MT， and sleep time correction can effectively reverse the abovementioned phenomenon.

【Key words】 sleep deprivation; type 2 diabetes mellitus; glucose and lipid metabolism; inflammatory factor; MT

2型糖尿病具有較高发病率，同时，受疾病自身、社会压力及生活压力增大等影响，患者睡眠习惯发生改变，存在不同程度睡眠剥夺[1]。研究表明，睡眠剥夺可造成神经内分泌功能紊乱、内源性激素分泌紊乱、交感神经兴奋，且睡眠剥夺不仅是糖尿病发病的危险因素，且可影响血糖控制效果，并增加并发症发生风险，加重患者经济负担[2]。此外，糖脂代谢状态及炎性因子表达在2型糖尿病发病及进展中具有重要作用，而褪黑素（MT）具备抗炎、抗氧化应激、抗凋亡等广泛的生物学功能，且褪黑素对糖尿病等代谢性疾病并发神经系统病变、视网膜病变具有一定保护作用[3]。……