阻塞性睡眠呼吸暂停低通气综合征患者不同程度氧减指数与肾功能早期损害
|
摘要
目的探讨阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)不同程度的氧减指数(oxygen reduction index,ODI)与患者早期肾功能损害的关系。方法选取经多导睡眠(polysomnography,PSG)监测并诊断为OSAHS的患者187例,按照不同ODI区间(轻度5≤ODI<15、中度15≤ODI<30、重度ODI≥30)分为3组,比较3组患者在血清胱抑素C(serum cystine C,s Cys-C)、血清尿素氮(blood urea nitrogen,BUN)、血清肌酐(serum creatinine,SCr)、血清β_2微球蛋白(serumβ_2 microglobulin,β_2-MG)、超氧化物歧化酶(superoxide dismutase,SOD)、尿N-乙酰-β-D氨基葡萄糖苷(N-acetyl-β-d glucosamine,NAG)方面的差异及相关性。结果各组间相关性分析发现,ODI指数与AHI、BMI、性别、高血压发病率存在明显正相关。各组患者指标分析中s Cys-C、β_2-MG、SOD、尿NAG随着ODI指数升高有明显升高趋势,组间比较有统计学意义(P<0.05); ODI与s Cys-C、β_2-MG、尿NAG呈正相关,与SOD水平呈负相关。结论重度ODI升高的OSAHS患者存在肾功能的早期损害。
Objective To explore the relationship between oxygen reduction index (ODI) and early renal impairment in the patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods A total of 187 patients,who were diagnosed as OSAHS by polysomnography (PSG),were divided into three groups according to their ODI (mild: 5 ≤ ODI < 15; moderate: 15 ≤ ODI < 30; and severe: ODI ≥ 30). The three groups were compared in their serum cystatin C (sCys-C),serum urea nitrogen (BUN),serum creatinine (SCr),serum beta 2-microglobulin (beta 2-MG),superoxide dismutase (SOD) and urinary N-acetyl-beta-D glucosaminide (NAG) and other differences. And the correlation was analyzed between the above-mentioned indexes and their ODIs. Results Significant differences were found in sCys-C,β_2-MG,SOD and urinary NAG among the three groups (P<0.05). And ODI was positively correlated with sCys-C,β_2-MG and urinary NAG,and negatively correlated with the level of SOD. Conclusion The patients with OSAHS having a high level of ODI often suffer from an early impairment of the renal function.
Objective To explore the relationship between oxygen reduction index (ODI) and early renal impairment in the patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods A total of 187 patients,who were diagnosed as OSAHS by polysomnography (PSG),were divided into three groups according to their ODI (mild: 5 ≤ ODI < 15; moderate: 15 ≤ ODI < 30; and severe: ODI ≥ 30). The three groups were compared in their serum cystatin C (sCys-C),serum urea nitrogen (BUN),serum creatinine (SCr),serum beta 2-microglobulin (beta 2-MG),superoxide dismutase (SOD) and urinary N-acetyl-beta-D glucosaminide (NAG) and other differences. And the correlation was analyzed between the above-mentioned indexes and their ODIs. Results Significant differences were found in sCys-C,β_2-MG,SOD and urinary NAG among the three groups (P<0.05). And ODI was positively correlated with sCys-C,β_2-MG and urinary NAG,and negatively correlated with the level of SOD. Conclusion The patients with OSAHS having a high level of ODI often suffer from an early impairment of the renal function.
引文
1 Shanmugam GV,Abraham G,Mathew M,et al.Obstructive sleep apnea in non-dialysis chronic kidney disease patients[J].Ren Fail,2015,37(2):214-218.
2 Mazière S,Pépin JL,Siyanko N,et al.P210:Usefulness of oximetry for sleep apnea screening in frail hospitalized elderly[J].J Am Med Dir Assoc,2014,15(6):447.e9-14.
3中华医学会呼吸病学分会睡眠呼吸障碍学组.阻塞性睡眠呼吸暂停低通气综合征诊治指南(2011年修订版)[J].柳州医学,2012,35(1):162-165.
4 Berg S.Obstructive sleep apnoea syndrome:current status[J].Clin Respir J,2010,2(4):197-201.
5 Nanduri J,Yuan G,Kumar GK,et al.Transcriptional responses to intermittent hypoxia[J].Respir Physiol Neurobiol,2008,164(1):277-281.
6 Ling IT,James AL,Hillman DR.Interrelationships between body mass,oxygen desaturation,and apnea-hypopnea indices in a sleep clinic population[J].Sleep,2012,35(1):89-96.
7 Torre-Bouscoulet L,Castorena-Maldonado A,Ba1os-Flores R,et al.Agreement between oxygen desaturation index and apnea-hypopnea index in adults with suspected obstructive sleep apnea at an altitude of 2 240 m[J].Arch Bronconeumol,2007,43(12):649-654.
8李涛平.阻塞性睡眠呼吸暂停低通气综合征与多器官疾病的关系[J/CD].中华肺部疾病杂志(电子版),2011,4(4):259-264.
9 Zelveian PA,Dgerian LG.The main pathophysiological mechanisms of kidney injury in obstructive sleep apnea syndrome[J].Ter Arkh,2014,86(6):100-105.
10 Abdullah O,Asiye K,Ali Riza O,et al.Obstructive sleep apnea syndrome and chronic kidney disease:a new cardiorenal risk factor[J].Clin Exp Hypertens,2014,36(4):211-216.
11 Hanly PJ,Ahmed SB.Sleep apnea and the kidney:is sleep apnea a risk factor for chronic kidney disease?[J].Chest,2014,146(4):1114-1122.
12 Sim JJ,Rasgon SA,Derose SF.Review article:Managing sleep apnoea in kidney diseases[J].Nephrology,2010,15(2):146-152.
13 Mavanur M,Sanders M,Unruh M.Sleep disordered breathing in patients with chronic kidney disease[J].Indian J Med Res,2010,131(2):277-284.
14钟旭,肖毅,黄蓉.阻塞性睡眠呼吸暂停低通气综合征对血管内皮功能及自主神经调制的影响[J].中国医学科学院学报,2010,32(2):162-166.
15 B9kenkamp A,Herget-Rosenthal S,B9kenkamp R.Cystatin C,kidney function and cardiovascular disease[J].Pediatr Nephrol,2006,22(3):1223-1230.
16 Hermida J,Tutor JC.Comparison of estimated glomerular filtration rates from serum creatinine and cystatin C in patients with impaired creatinine production[J].Clin Lab,2006,52(9-10):483-490.
17 Hong JD,Lim IS.Correlation between glomerular filtration rate and urinary N acetyl-beta-D glucosaminidase in children with persistent proteinuria in chronic glomerular disease[J].Korean J Pediatr,2012,55(4):136-142.
18曾奕明,陈晓阳,黄子扬,等.模拟睡眠呼吸暂停缺氧/再氧合对小鼠心肾超微结构的影响[J].复旦学报(医学版),2006,33(1):84-88.
19罗国仕,涂明利,杜春玲,等.阻塞性睡眠呼吸暂停低通气综合征患者血清胱抑素C测定及临床意义[J].湖北医药学院学报,2009,28(4):348-350.
20 Canales MT,Taylor BC,Ishani A,et al.Reduced renal function and sleep-disordered breathing in community-dwelling elderly men[J].Sleep Med,2008,9(6):637-645.
21 Kato K,Takata Y,Usui Y,et al.Severe obstructive sleep apnea increases cystatin C in clinically latent renal dysfunction[J].Respir Med,2011,105(4):643-649.
22 Zhang XB,Lin QC,Deng CS,et al.Elevated serum cystatin C in severe OSA younger men without complications[J].Sleep Breath,2013,17(1):235-241.
23于莉.阻塞性睡眠呼吸暂停综合征患者血清β2微球蛋白的测定及临床意义[J].济宁医学院学报,2009,32(1):37-38.
24管青,张弘.多指标联合检测在糖尿病早期肾损伤中的临床应用[J].国际检验医学杂志,2012,33(18):2291-2292.
25姚海林,欧阳庆,周群.尿GAL、NAG、AAP及LAP联合检测在肾脏功能损伤中的应用[J].实验与检验医学,2009,27(5):463-464.
26余勤,汪小亚,岳红梅,等.血清胱蛋白酶抑制剂C及尿酶对阻塞性睡眠呼吸暂停低通气综合征早期肾功能损害的诊断价值[J].兰州大学学报(医学版),2008,34(1):13-16.
27吴伟岚,卫敏江,陈敏怡,等.尿α1-MG和尿NAG与肾小管间质病理变化的关系[J].上海交通大学学报(医学版),2004,24(5):357-358.
28 Stiefel P,Sánchez-Armengol MA,Villar J,et al.Obstructive sleep apnea syndrome,vascular pathology,endothelial function and endothelial cells and circulating microparticles[J].Arch Med Res,2013,44(6):409-414.
2 Mazière S,Pépin JL,Siyanko N,et al.P210:Usefulness of oximetry for sleep apnea screening in frail hospitalized elderly[J].J Am Med Dir Assoc,2014,15(6):447.e9-14.
3中华医学会呼吸病学分会睡眠呼吸障碍学组.阻塞性睡眠呼吸暂停低通气综合征诊治指南(2011年修订版)[J].柳州医学,2012,35(1):162-165.
4 Berg S.Obstructive sleep apnoea syndrome:current status[J].Clin Respir J,2010,2(4):197-201.
5 Nanduri J,Yuan G,Kumar GK,et al.Transcriptional responses to intermittent hypoxia[J].Respir Physiol Neurobiol,2008,164(1):277-281.
6 Ling IT,James AL,Hillman DR.Interrelationships between body mass,oxygen desaturation,and apnea-hypopnea indices in a sleep clinic population[J].Sleep,2012,35(1):89-96.
7 Torre-Bouscoulet L,Castorena-Maldonado A,Ba1os-Flores R,et al.Agreement between oxygen desaturation index and apnea-hypopnea index in adults with suspected obstructive sleep apnea at an altitude of 2 240 m[J].Arch Bronconeumol,2007,43(12):649-654.
8李涛平.阻塞性睡眠呼吸暂停低通气综合征与多器官疾病的关系[J/CD].中华肺部疾病杂志(电子版),2011,4(4):259-264.
9 Zelveian PA,Dgerian LG.The main pathophysiological mechanisms of kidney injury in obstructive sleep apnea syndrome[J].Ter Arkh,2014,86(6):100-105.
10 Abdullah O,Asiye K,Ali Riza O,et al.Obstructive sleep apnea syndrome and chronic kidney disease:a new cardiorenal risk factor[J].Clin Exp Hypertens,2014,36(4):211-216.
11 Hanly PJ,Ahmed SB.Sleep apnea and the kidney:is sleep apnea a risk factor for chronic kidney disease?[J].Chest,2014,146(4):1114-1122.
12 Sim JJ,Rasgon SA,Derose SF.Review article:Managing sleep apnoea in kidney diseases[J].Nephrology,2010,15(2):146-152.
13 Mavanur M,Sanders M,Unruh M.Sleep disordered breathing in patients with chronic kidney disease[J].Indian J Med Res,2010,131(2):277-284.
14钟旭,肖毅,黄蓉.阻塞性睡眠呼吸暂停低通气综合征对血管内皮功能及自主神经调制的影响[J].中国医学科学院学报,2010,32(2):162-166.
15 B9kenkamp A,Herget-Rosenthal S,B9kenkamp R.Cystatin C,kidney function and cardiovascular disease[J].Pediatr Nephrol,2006,22(3):1223-1230.
16 Hermida J,Tutor JC.Comparison of estimated glomerular filtration rates from serum creatinine and cystatin C in patients with impaired creatinine production[J].Clin Lab,2006,52(9-10):483-490.
17 Hong JD,Lim IS.Correlation between glomerular filtration rate and urinary N acetyl-beta-D glucosaminidase in children with persistent proteinuria in chronic glomerular disease[J].Korean J Pediatr,2012,55(4):136-142.
18曾奕明,陈晓阳,黄子扬,等.模拟睡眠呼吸暂停缺氧/再氧合对小鼠心肾超微结构的影响[J].复旦学报(医学版),2006,33(1):84-88.
19罗国仕,涂明利,杜春玲,等.阻塞性睡眠呼吸暂停低通气综合征患者血清胱抑素C测定及临床意义[J].湖北医药学院学报,2009,28(4):348-350.
20 Canales MT,Taylor BC,Ishani A,et al.Reduced renal function and sleep-disordered breathing in community-dwelling elderly men[J].Sleep Med,2008,9(6):637-645.
21 Kato K,Takata Y,Usui Y,et al.Severe obstructive sleep apnea increases cystatin C in clinically latent renal dysfunction[J].Respir Med,2011,105(4):643-649.
22 Zhang XB,Lin QC,Deng CS,et al.Elevated serum cystatin C in severe OSA younger men without complications[J].Sleep Breath,2013,17(1):235-241.
23于莉.阻塞性睡眠呼吸暂停综合征患者血清β2微球蛋白的测定及临床意义[J].济宁医学院学报,2009,32(1):37-38.
24管青,张弘.多指标联合检测在糖尿病早期肾损伤中的临床应用[J].国际检验医学杂志,2012,33(18):2291-2292.
25姚海林,欧阳庆,周群.尿GAL、NAG、AAP及LAP联合检测在肾脏功能损伤中的应用[J].实验与检验医学,2009,27(5):463-464.
26余勤,汪小亚,岳红梅,等.血清胱蛋白酶抑制剂C及尿酶对阻塞性睡眠呼吸暂停低通气综合征早期肾功能损害的诊断价值[J].兰州大学学报(医学版),2008,34(1):13-16.
27吴伟岚,卫敏江,陈敏怡,等.尿α1-MG和尿NAG与肾小管间质病理变化的关系[J].上海交通大学学报(医学版),2004,24(5):357-358.
28 Stiefel P,Sánchez-Armengol MA,Villar J,et al.Obstructive sleep apnea syndrome,vascular pathology,endothelial function and endothelial cells and circulating microparticles[J].Arch Med Res,2013,44(6):409-414.