老年阻塞性睡眠呼吸暂停低通气综合征患者血清尿酸水平测定的意义

Clinical significance of serum uric acid levels in elderly patients with obstructive sleep apnea hypopnea syndrome

目的探讨老年阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者血清尿酸水平的变化及意义。方法收集2012年1月至2014年12月在福建医科大学附属第一医院睡眠障碍疾病诊治中心行多导睡眠呼吸监测（PSG）的老年患者（年龄≥60岁），根据2011年中华医学会呼吸病学分会睡眠呼吸障碍学组制定的诊断标准将其分为单纯性鼾症组、轻度OSAHS组、中度OSAHS组和重度OSAHS组，并匹配各组年龄、性别和基础疾病后，比较各组患者血清尿酸、血糖、血脂和超敏C反应蛋白（hs-CRP）水平，行Spearman秩相关与逐步线性回归分析与血清尿酸相关的独立危险因素。结果共收集129例老年患者，男性100例，女性29例，平均年龄（63．6±2．3）岁，其中单纯性鼾症组23例、轻度OSAHS组24例，中度OSAHS组39例，重度OSAHS组43例；与单纯性鼾症组比较，重度OSAHS血清尿酸及hsCRP水平升高（均P〈0．05）。Spearman相关分析结果显示，血清尿酸水平与呼吸暂停低通气指数（AHI）、（ODI）呈正相关（r=0．251、0．210，P=0．004、0．018）。以血清尿酸水平为因变量的逐步线性回归分析结果显示，仅AHI为引起血清尿酸水平升高的独立危险因素（β=0．354，P=0．000）。结论老年重度OSAHS患者血清尿酸水平升高，AHI是引起血清尿酸水平升高的独立危险因素。

Objective To investigate the significance of changes in serum uric acid levels in elderly patients with obstructive sleep apnea hyponea syndrome （OSAHS）. Methods The study recruited elderly patients aged 60 years and over undergoing polysomnography （PSG） at the Center for Diagnosis and Treatment of Sleep Disorders of our hospital from January 2012 to December 2014. According to the diagnostic criteria established by the Group of Sleep and Breathing Disorders, Respiratory Diseases Branch, Chinese Medical Association （2011）, patients were divided into the simple snoring group, the mild OSAHS group, the moderate OSAHS group and the severe OSAHS group. Levels of serum uric acid, blood glucose, blood lipids and high-sensitive C-reactive protein （hs- CRP） were compared between all groups after adjusting for age, gender and underlying diseases. Independent risk factors associated with serum uric acid were analyzed using Spearman＇s rank correlation and stepwise multivariate analysis. Results A total of 129 elderly subjects including 100 males and 29 females, with a mean age of （63.6±2.25） years, were enrolled. Of these subjects, 23 were grouped as simple snoring, 24 as mild OSAHS, 39 as moderate OSAHS and 43 as severe OSAHS. Serum uric acid and hs-CRP levels were increased in the severe OSAHS group as compared with the simple snoring group （both P〈0.05）. Spearman＇s rank correlation analysis showed that the apnea-hypopnea index （AHI） and the oxygen desaturation index （ODD were positively correlated with the serum uric acid level （r = 0. 251 and 0. 210, P = 0. 004 and 0. 018, respectively） . Stepwise multivariate analysis showed that, with serum uric acid level as the dependent variable, AHI was an independent risk factor for increased serum uric acid levels （β= 0. 354, P= 0. 000）. Conclusions Serum uric acid levels are elevated in elderly patients with severe OSAHS, and AHI is an independentrisk factor for the increased serum uric acid levels.