阻塞性睡眠呼吸暂停低通气综合征合并2型糖尿病诱发早期肾功能受损的危险因素分析

Analyzing risk factors for early renal function impairment induced by obstructive sleep apnea hypopnea syndrome with type 2 diabetes mellitus

目的研究阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并2型糖尿病(T2DM)诱发早期肾功能受损的危险因素,为T2DM患者肾功能受损的早期防治提供参考。方法选取2013年8月至2016年8月天津市塘沽区向阳医院收治的352例T2DM患者为研究对象,按照血清胱抑素C(CysC)水平,将CysC>1.15 mg/L的患者纳入早期肾功能受损组(78例),将CysC≤1.15 mg/L的患者纳入无早期肾功能受损组(274例)。收集患者的年龄、性别、体质指数(BMI)和糖尿病病程等基线资料,测定CysC、血糖、血常规、血脂等指标。按照患者是否合并OSAHS、OSAHS病情,分为单纯糖尿病、轻度OSAHS、中度OSAHS和重度OSAHS。用SPSS 18.0软件进行t检验、χ~2检验,以CysC水平作为预测早期肾功能状况的指标,采用多因素logistic回归分析OSAHS合并T2DM患者早期肾功能损伤的影响因素。结果 352例患者中,78例患者发生早期肾功能受损,发生率为22.16%。单纯糖尿病患者72例,轻度OSAHS患者103例,中度OSAHS患者96例,重度OSAHS患者81例。早期肾功能损伤组BMI、呼吸暂停低通气指数(AHI)、CysC、白细胞(WBC)、空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(Hb A1C)水平和男性比例均高于无早期肾功能损伤组,差异均有统计学意义(P<0.05)。OSAHS病情、男性(OR=1.84)和高Hb A1C水平(OR=3.18)是导致OSAHS合并T2DM患者发生早期肾功能受损的危险因素,均有统计学意义(P<0.05,P<0.01),且随着OSAHS患者病情分级的上升,其OR值逐渐升高,由2.37逐渐升至3.49、4.28。结论严格控制血糖水平,纠正OSAHS有利于降低OSAHS合并T2DM患者早期肾功能受损风险。

Objective To analyze the risk factors for early renal function impairment induced by obstructive sleep apnea hypopnea syndrome（OSAHS） with type 2 diabetes mellitus, and to provide some references of early prevention for patients with renal function impairment. Methods The subjects were 352 inpatients with type 2 diabetes mellitus（T2DM） in the hospital from August2013 to August 2016. All subjects were divided into early renal function impairment group（CysC〉1.15 mg/L, 78 cases） and nonearly renal function impairment group（CysC ≤1.15 mg/L, 274 cases）. The data of age, gender, BMI and T2DM duration were collected for all subjects. The levels of serum cystatin（Cys-C）, blood glucose, blood lipid and blood routine were measured for all subjects. Also the subjects were divided into patients with simple T2DM , patients with mild OSAHS, moderate OSAHS and severe OSAHS groups, according to OSAHS. The t test and χ~2test were used to analyze the data. The multivariate logistic regression model was used to analyze the influencing factors of T2DM patients with OSAHS combined with early renal function impairment. The used software was SPSS 18.0. Results The morbidity of early renal function impairment was 22.16%. There were 72 cases with simple T2DM , 103 cases with mild OSAHS, 96 cases with moderate OSAHS and 81 cases with severe OSAHS among 352 subjects.The male proportion, levels of BMI, AHI, CysC, WBC, FPG, 2 h PG and Hb A1 Cin early renal function impairment group were significantly higher than those in non-early renal function impairment group（P〈 0.05）. The risk factors of early renal function impairment in patients with T2DM plus OSAHS were OSAHS condition, male and high Hb A1Clevel（P0.05, P0.01）. OR values increased with OSAHS condition（from 2.37 to 3.49, 4.28）. Conclusion Controlling blood glucose and correcting OSAHS could decrease the risk of early renal function impairment for T2DM patients with OSAHS.