阻塞性睡眠呼吸暂停综合征患者肾功能损害情况及危险因素分析

Analysis of risk factors of renal function impairment among patients with obstructive sleep apnea syndrome

目的探讨阻塞性睡眠呼吸暂停综合征(OSAS)患者肾功能损害的主要早期表现及可能存在的影响因素,为临床医生早期发现及诊治OSAS患者的肾功能损害提供科学依据。方法收集2015年1月~2016年1月至我院接受治疗的OSAS患者100例作为研究组,选择健康者100例作为对照组(AHI<5次/h)。根据睡眠呼吸暂停低通气指数(AHI)分为轻度(5≤AHI<15次/h)、中度(15≤AHI<30次/h)及重度(AHI≥30次/h)OSAS患者。病例随访2年,所有研究对象均于清晨空腹抽取静脉血,测定患者血清尿素氮(BUN)、血肌酐(Scr)、尿蛋白/肌酐(ACR)、肾小球滤过率(eGFR)及血清胱抑素(Cys-C)等。评价OSAS引起早期肾损害的情况,并对其危险因素进行分析。结果与健康对照组比较,轻、中、重度OSAS组BUN、Scr水平均升高(P<0.05)。OSAS组各组间比较:与轻度OSAS组比较,重度OSAS组Scr水平显著升高(P<0.05)。轻度OSAS组患者的Cys-C及eGFR水平显著优于中、重度OSAS组患者(P<0.05),但与对照组间无显著统计学差异(P>0.05)。另外,中度OSAS组患者Cys-C、eGFR水平优于重度OSAS组患者,比较差异均有统计学意义(P均<0.05)。Pearson相关性及多重线性回归分析结果显示:eGFR与年龄、BMI、AHI呈负相关(P<0.001);Cys-C与AHI、BMI及体重呈正相关(P<0.05),与LSaO 2呈负相关(P<0.05);BUN与体重呈正相关(P<0.05)但与AHI无相关性;Scr与BMI及AHI呈正相关(P<0.01),eGFR、BUN及Scr与LSaO 2均无相关性。结论OSAS患者肾功能损害程度随着OSAS病情的加重而逐渐加剧,Scr、eGFR、Cys-C等肾功能指标可以作为OSAS患者早期肾功能损害的检测指标。

Objective To explore the main early manifestations and possible influencing factors of renal dysfunction in obstructive sleep apnea hypopnea syndrome(OSAS)patients,and to provide scientific basis for clinicians to detect,diagnose and treat renal dysfunction in OSAS patients at early stage.Methods 100 cases of OSAS patients were collected as the study group who received treatment in the department of respiratory medicine of our hospital from January 2015 to January 2016,and 100 cases of healthy subjects were selected as the control group.Patients with sleep apnea hypopnea index(AHI)were classified as mild(5≤AHI<15 time/h),moderate(15≤AHI<30 time/h),and severe(AHI≥30 time/h)cases.They were followed up for 2 years.Venous blood was extracted from all subjects on an empty stomach in the morning,and blood urea nitrogen(BUN),blood creatinine(Scr),urine protein/creatinine(ACR),glomerular filtration rate(eGFR)and serum cystatin Cys-C)were measured.The risk factors of early renal damage induced by OASA were analyzed.Results Compared with the healthy control group,the levels of BUN and Scr in the mild,moderate and severe OSAS groups were all increased(P<0.05).Compared with the mild OSAS group,Scr level increased more obviously in the severe OSAS group(P<0.05),but there was no significant difference in Cys-C and GFR levels between the mild OSAS patients and the healthy control group(P>0.05),and they were all superior to the Cys-C and GFR levels of moderate and severe OSAS patients,and the Cys-C and GFR levels of moderate OSAS patients were superior to those of severe OSAS patients,with statistically significant difference(P<0.05).The proportion of patients with abnormal renal function indicators in the OSAS group was higher than that in the normal group(P<0.05).Pearson correlation analysis showed that eGFR wasnegatively correlated with age,BMI,and AHI(P<0.001).Cys-C was positively correlated with AHI,BMI and body weight(P<0.05),and negatively correlated with LSaO 2(P<0.05).BUN was positively correlated with body weight(P<0.05),but was not correlated with AHI.Scr was positively correlated with BMI and AHI(P<0.01),while eGFR,BUN and Scr were not correlated with LSaO 2.Conclusion The degree of renal function damage of OSAS patients is aggravated with the aggravation of OSAS,and BUN,Scr,ACR,eGFR,Cys-C and other renal function indexes could be used as detection indexes for early renal function damage in OSAS patients.Therefore,OSAS patients should be clinically tested for relevant renal function indicators as early as possible,in order to take appropriate treatment for OSAS patients.