阻塞性睡眠呼吸暂停低通气综合征患者不同程度氧减指数与肾功能早期损害

doi:10.3877/cma.j.issn.1674-6902.2019.02.002

目的

探讨阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome, OSAHS)不同程度的氧减指数(oxygen reduction index, ODI)与患者早期肾功能损害的关系。

方法

选取经多导睡眠(polysomnography, PSG)监测并诊断为OSAHS的患者187例，按照不同ODI区间(轻度5≤ODI<15、中度15≤ODI<30、重度ODI≥30)分为3组，比较3组患者在血清胱抑素C(serum cystine C, sCys-C)、血清尿素氮(blood urea nitrogen, BUN)、血清肌酐(serum creatinine, SCr)、血清β₂微球蛋白(serum β2 microglobulin, β₂-MG)、超氧化物歧化酶(superoxide dismutase, SOD)、尿N-乙酰-β-D氨基葡萄糖苷(N-acetyl-β-d glucosamine, NAG)方面的差异及相关性。

结果

各组间相关性分析发现，ODI指数与AHI、BMI、性别、高血压发病率存在明显正相关。各组患者指标分析中sCys-C、β₂-MG、SOD、尿NAG随着ODI指数升高有明显升高趋势，组间比较有统计学意义(P<0.05)；ODI与sCys-C、β₂-MG、尿NAG呈正相关，与SOD水平呈负相关。

结论

重度ODI升高的OSAHS患者存在肾功能的早期损害。

关键词: 低通气综合征，睡眠呼吸暂停，阻塞性, 氧减指数, 肾功能, 胱抑素C

Objective

To explore the relationship between oxygen reduction index (ODI) and early renal impairment in the patients with obstructive sleep apnea-hypopnea syndrome (OSAHS).

Methods

A total of 187 patients, who were diagnosed as OSAHS by polysomnography (PSG), were divided into three groups according to their ODI (mild: 5≤ODI<15; moderate: 15≤ODI<30; and severe: ODI≥30). The three groups were compared in their serum cystatin C (sCys-C), serum urea nitrogen (BUN), serum creatinine (SCr), serum beta 2-microglobulin (beta 2-MG), superoxide dismutase (SOD) and urinary N-acetyl-beta-D glucosaminide (NAG) and other differences. And the correlation was analyzed between the above-mentioned indexes and their ODIs.

Results

Significant differences were found in sCys-C, β₂-MG, SOD and urinary NAG among the three groups (P<0.05). And ODI was positively correlated with sCys-C, β₂-MG and urinary NAG, and negatively correlated with the level of SOD.

Conclusion

The patients with OSAHS having a high level of ODI often suffer from an early impairment of the renal function.

Key words: Obstructive sleep apnea-hypopnea syndrome, Oxygen reduction index, Renal function, Serum cystatin C

表1 各组临床特征的统计描述及单因素分析比较结果(±s)

组　别	例数	男性[n(%)]	年龄[(±s)，岁]	BMI[(±s)，kg/cm²]	AHI(±s)	高血压[n(%)]	糖尿病[n(%)]	冠心病[n(%)]
轻度组(5≤ODI<15)	56	34(60.7)	51.25±9.41	24.77±2.64	8.6±2.46	6(10.71)	7(12.5)	3(5.4)
中度组(15≤ODI<30)	67	52(77.6)^a	53.16±10.18	25.74±2.86	21.3±5.43^a	17(25.4)^a	9(13.4)	4(6.0)
重度组(ODI≥30)	64	53(82.8)^a	52.79±10.73	28.05±2.56^ab	55.7±13.16^ab	22(34.4)^a	9(14.1)	4(6.3)

表1 各组临床特征的统计描述及单因素分析比较结果(±s)

组　别	例数	男性[n(%)]	年龄[(±s)，岁]	BMI[(±s)，kg/cm²]	AHI(±s)	高血压[n(%)]	糖尿病[n(%)]	冠心病[n(%)]
轻度组(5≤ODI<15)	56	34(60.7)	51.25±9.41	24.77±2.64	8.6±2.46	6(10.71)	7(12.5)	3(5.4)
中度组(15≤ODI<30)	67	52(77.6)^a	53.16±10.18	25.74±2.86	21.3±5.43^a	17(25.4)^a	9(13.4)	4(6.0)
重度组(ODI≥30)	64	53(82.8)^a	52.79±10.73	28.05±2.56^ab	55.7±13.16^ab	22(34.4)^a	9(14.1)	4(6.3)

表2 各组患者ODI与生化检验结果(±s)

组　别	血Cys-C[(±s)mg/L]	BUN[(±s)mmol/L]	SCr[(±s)μmol/L]	血β₂-MG[(±s)mg/L]	尿NAG[(±s)U/mmol]	SOD[(±s)U/ml]
轻度组(5≤ODI<15)	0.89±0.21	4.43±1.56	70.22±13.69	2.06±0.32	4.72±1.56	139.20±9.63
中度组(15≤ODI<30)	0.93±0.15	5.18±1.67	70.94±14.13	1.97±0.15	4.98±1.70	136.18±11.77
重度组(ODI≥30)	1.17±0.16^ab	5.09±2.04	72.36±11.98	2.58±0.26^ab	6.58±1.77^ab	130.04±8.69^ab

表2 各组患者ODI与生化检验结果(±s)

组　别	血Cys-C[(±s)mg/L]	BUN[(±s)mmol/L]	SCr[(±s)μmol/L]	血β₂-MG[(±s)mg/L]	尿NAG[(±s)U/mmol]	SOD[(±s)U/ml]
轻度组(5≤ODI<15)	0.89±0.21	4.43±1.56	70.22±13.69	2.06±0.32	4.72±1.56	139.20±9.63
中度组(15≤ODI<30)	0.93±0.15	5.18±1.67	70.94±14.13	1.97±0.15	4.98±1.70	136.18±11.77
重度组(ODI≥30)	1.17±0.16^ab	5.09±2.04	72.36±11.98	2.58±0.26^ab	6.58±1.77^ab	130.04±8.69^ab

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Relationship between oxygen reduction index and early impairment of renal function in patients with obstructive sleep apnea-hypopnea syndrome

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Relationship between oxygen reduction index and early impairment of renal function in patients with obstructive sleep apnea-hypopnea syndrome