南方医科大学学报

南方医科大学学报 ›› 2016, Vol. 36 ›› Issue (03): 339-.

• • 上一篇    下一篇

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

蒋倩，李涛平，庞礡，王啸，王玉峰   

  • 出版日期:2016-03-20 发布日期:2016-03-20

Severe obstructive sleep apnea-hypopnea syndrome with latent renal dysfunction: analysis of 238 cases   

  • Online:2016-03-20 Published:2016-03-20

HTML

PDF

1542

摘要： 目的观察未合并慢性肾脏病（CKD）的不同程度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者血清胱抑素C（Cys-C） 浓度变化，探讨其与整夜多导睡眠检测（PSG）指标的相关性。方法收集2012年1月至2015年6月南方医科大学南方医院呼吸 睡眠中心初诊的睡眠打鼾患者，共238例。所有患者完善病史、人体学特征采集、PSG监测及血清胱抑素C浓度、血常规、血糖、 血脂等生化检测，根据AHI值将其分为单纯性鼾症组（AHI<5），轻度（AHI, 5-15），中度（AHI，15-30）及重度OSAHS（AHI>30） 组，比较各组间Cys-C浓度差异及其与PSG指标的相关性。结果238例患者中单纯性鼾症患者41例，OSAHS患者197例，包括 轻度、中度、重度各49、56、92例。各组间各指标单因素分析结果示：重度OSAHS患者血清Cys-C浓度、外周血白细胞（WBC）及 其亚型计数、红细胞（RBC）计数、超氧化物歧化酶（SOD）较轻度、中度OSAHS患者及单纯性鼾症患者明显升高，差异有统计学 意义（P<0.05），同时各组间血肌酐（Cr）浓度及肾小球率过滤（eGFR）差异无统计学意义（P>0.05）。相关性分析示，血清Cys-C浓 度与性别、BMI、颈围、腹围、SBP、呼吸暂停低通气指数（AHI）、WBC呈正相关（P均<0.01），与平均血氧饱和度（ASpO2）、最低血 氧饱和度（MSpO2）、SOD呈负相关（P均<0.01）。多元线性回归分析调整上述相关指标后，AHI值与血清Cys-C浓度的升高呈独 立正相关（β=0.218，P<0.010），SOD与血清Cys-C浓度的升高呈独立负相关（β= -0.217，P<0.009）。结论重度OSAHS可能启动 了早期肾功能损害的病理过程，其损害机制可能与慢性间歇性低氧（CIH）诱发氧化应激、启动炎症级联反应相关。

Abstract: Objective To evaluate the association between severity of obstructive sleep apnea hypopnea syndrome (OSAHS) without chronic kidney disease (CKD) and serum cystatin C. Methods A total of 238 patients with snoring during sleep admitted between January 2012 and June 2015 underwent full-night polysomnography for diagnosis of OSAHS. The patients were divided according to the apnea-hypopnea index (AHI) scores into simple snoring group (AHI<5) and mild (AHI, 5-15), moderate (AHI, 15-30), and severe OSAHS (AHI>30) groups. The medical history, baseline demographic characteristics, blood glucose, blood lipids, peripheral blood cell count and serum cystatin C were measured, and the correlation between polysomnographic parameters and serum cystatin C were analyzed in different groups. Results The simple snoring, mild, moderate, and severe OSAHS groups consisted of 41, 49, 56, and 92 cases, respectively. Serum cystatin C, WBC and its subtype counts, RBC count, and superoxide dismutase (SOD) were all significantly higher in severe OSAHS group than in the other 3 groups (P<0.05), but serum creatinine and estimated glomerular filtration rate were comparable among the groups (P>0.05). Linear correlation analysis revealed that serum cystatin C was positively correlated with gender, BMI, neck circumference, abdominal circumference, SBP, AHI, and WBC (P<0.01) and inversely correlated with the average pulse oxygen saturation (ASpO2), minimum pulse oxygen saturation (MSpO2), and SOD (P<0.01). Multiple regression analysis identified AHI and SOD as independent factors that were positively and inversely correlated with serum cystatin C (β =0.218, P<0.010; β =-0.217, P< 0.009), respectively. Conclusion Severe OSAHS is closely correlated with serum cystatin C, WBC, and SOD, suggesting that severe OSAHS may initiate the pathological process of early renal damage possibly in association with chronic intermittent hypoxia-induced oxidative stress and the initiation of the inflammatory cascade.