阻塞性睡眠呼吸暂停低通气综合征对2型糖尿病肾病的影响及血管内皮生长因子与2型糖尿病肾病的相关性分析

Effect of obstructive sleep apnea hypopnea syndrome on type 2 diabetic nephropathy and analysis of the correlation between vascular endothelial growth factor and type 2 diabetic nephropathy

目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与血糖波动、2型糖尿病肾病(DN)的关系及血管内皮生长因子(VEGF)与DN的相关性。方法纳入2型糖尿病(T2DM)患者262例,根据呼吸暂停低通气指数(AH1)将其分为非OSAHS、OSAHS轻度、中度、重度4组,收集患者的临床资料、AHI、夜间最低脉氧饱和度(LSPO2)、血糖波动指标及血清VEGF水平并进行比较。采用多因素logistic回归分析评估影响DN的因素。结果OSAHS轻、中、重度组患者AHI、平均血糖波动幅度(MAGE)、血糖值的标准差(SDBG)、日间平均血糖绝对差(M0DD)、最大血糖波动幅度(LAGE)、血糖<3.9mmol/L和血糖>11.1mmol/L时间百分比、血清VEGF水平明显高于非OSAHS组(P<0.05);随着OSAHS严重程度的增加,DN发生率、VEGF水平逐渐升高(P<0.05);DN组患者VEGF水平明显高于非DN组[(239.6±23.7)ng/L与(46.3±19.3)ng/L,P<0.05];多因素logistic回归分析结果显示,病程、AHI、LSP02、MACE、SDBG、LADE、糖化血红蛋白(HbAlc)、VEGF是DN的独立影响因素(P<0.05).结论T2DM伴OSAHS患者的血糖波动频率更高、幅度更大。DN的发生可能与OSAHS的轻重程度呈正相关。DN患者VEGF水平明显升高,且与OSAHS的严重程度呈正相关。

Objective To investigate the relationship of obstructive sleep apnea hypopnea syndrome(OSAHS),blood glucose fluctuation,type 2 diabetic nephropathy(DN)and the correlation between vascular endothelial growth factor(VEGF)with DN.Methods A total of 262 type 2 diabetic patients were enrolled and divided into 4 groups:non-OSAHS,mild,moderate and severe group according to apnea hypopnea index(AHI).Clinical data,AHI,nocturnal minimum pulse oxygen saturation(LSPO2),blood glucose fluctuation index and VEGF level were compaed among 4 groups.Multivariate logistic regression analysis was used to evaluate the factors affecting DN.Results AHI,mean blood glucose fluctuation(MAGE),standard deviation of blood glucose(SDBG),daytime mean blood glucose absolute difference(MODD),maximum blood glucose fluctuation(LAGE),the time percentage of blood glucose<3.9 mmol/L and blood glucose>11.1 mmol/L,VEGF level were significantly higher in mild,moderate and severe group than those in non-OSAHS group(P<0.05).With the increase of the severity of OSAHS,the incidence of DN and the VEGF level increased gradually(P<0.05).VEGF level in DN group was higher than that in non-DN group[(239.6±23.7)ng/L and(46.3±19.3)ng/L,P<0.05].Multivariate logistic regression analysis showed that course of disease,AHI,LSPO2,MACE,SDBG,LADE,HbAlc and VEGF were independent influencing factors of DN(P<0.05).Conclusion The fluctuation frequency of blood glucose is higher in patients with T2DM complicated with OSAHS.The severity of OSAHS is positively correlated with DN in T2DM patients.VEGF level is significantly increases in DN patients and is positively correlated with the severity of OSAHS.