重度阻塞性睡眠呼吸暂停低通气综合征患者启动早期肾损害

Effect of severe obstructive sleep apnea hypopnea syndrome on renal function

目的探讨重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)对患者肾脏的影响及其评价指标。方法回顾分析59例于湖北省天门市第一人民医院呼吸内科接受治疗的重度OSAHS患者(研究组)和45名体格检查健康者(对照组)的临床资料,对所有参与者进行8h的多导睡眠呼吸监测,并记录其血氧饱和度<90%的时间占睡眠总时间的百分比(TS90%)、平均动脉血氧饱和度(MS_aO_2)、呼吸暂停低通气指数(AHI)、最长呼吸暂停时间(LAT)和最低动脉血氧饱和度(LS_aO_2)。所有研究对象均于清晨空腹抽取静脉血,测定其血清胱抑素C(Cys-C)、心房钠尿肽(ANP)、氧化低密度脂蛋白(ox-LDL)水平;同时收集晨尿分别进行尿常规检查和尿N-乙酰-β-D-氨基葡萄糖苷酶(NAG)、尿微量白蛋白(MAU)检测,评价OSAHS引起早期肾损害的情况。结果研究组的AHI、TS90%、LAT、Cys-C、ANP、ox-LDL、NAG、MAU均显著高于对照组(P值分别<0.01、0.05),LS_aO_2、MS_aO_2均显著低于对照组(P值均<0.01)。结论 OSAHS患者由于夜间低氧和高碳酸血症会引发早期肾损伤,血清Cys-C、ANP、ox-LDL和尿NAG、MAU是反映其早期肾损伤的敏感指标。

Objective To evaluate the effect and assessment indices of obstructive sleep apnea hypopnea syndrome （OSAHS） on renal function. Methods Clinical data of 59 patients with severe OSAHS （study group） and 45 healthy adults receiving physical examination （control group） in our hospital were reviewed retrospectively. All the patients were monitored with polysomnography for 8 hours, and the percentage of total sleep time （TS90%）, mean arterial oxygen saturation （MSaO2）, apnea hypopnea index （AHI）, longest apnea time （LAT） and minimum arterial oxygen saturation （LSaO2） were recorded. The level of serum cystatin C （Cys- C）, atrial natriuretic peptide （ANP）, oxidized low density lipoprotein （ox-LDL） in serum and urine N-acetyl beta- D-amino glucosidase （NAG） and urinary microalbumin （MAU） were detected. Results The levels of AHI, TS90%, LAT, Cys-C, ANP, ox-LDL, NAG and MAU in the study group were significantly higher than those in the control group （P〈0.01, 0.05）, while the levels of LSaO2 and MS, Oz in the study group were significantly lower than those in the control group （both P〈0.01）. Conclusion Early renal impairment can be found in patients with OSAHS because of nocturnal hypoxemia and hypercapnia. Serum Cys-C, ANP, ox-LDL and urine NAG, MAU may be sensitive indicators for the diagnosis of early renal impairment.