老年重叠综合征患者早期肾损伤临床研究
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摘要
目的探讨重叠综合征(OS)早期肾损伤情况及相关指标分析。方法选取2014年1月至2018年8月南京市第一医院呼吸与危重症医学科收治的16例OS患者(OS组)及42例慢性阻塞性肺疾病(COPD)患者(COPD组),另选取同期不伴有缺氧性疾病的健康体检者30名(对照组)。分别测定各组肺功能指标1秒钟用力呼气容积占预计值百分比(FEV1%)、用力肺活量占预计值百分比(FVC%)和1秒钟用力呼气容积/用力肺活量(FEV1/FVC),血气分析指标氧分压(PaO_2)及二氧化碳分压(PaCO_2),肾功能指标血清尿素氮(BUN)、血肌酐(SCr)、内生肌酐清除率(Ccr)、胱抑素C(Cys-C)及β_2微球蛋白(β2-MG)水平。比较各组指标差异。采用SPSS 22.0软件进行统计分析。根据数据类型,组间比较采用方差分析、LSD两两比较或χ~2检验。Spearman秩相关法对Cys-C和β_2-MG与其他指标进行相关性分析。结果与对照组比较,OS和COPD组患者COPD评估测试(CAT)评分、PaCO_2、Cys-C及β2-MG显著升高,PaO_2、FEV1%、FVC%和FEV1/FVC显著降低,差异有统计学意义(P<0. 05),但3组BUN及SCr及Ccr差异无统计学意义(P>0. 05)。与COPD组比较,OS组患者CAT、Cys-C及β_2-MG显著升高,差异有统计学意义(P<0. 05)。相关性分析显示,Cys-C和β_2-MG与CAT评分呈正相关(Cys-C:r=0. 722,P=0. 000;β_2-MG:r=0. 287,P=0. 029),与PaO_2呈负相关(Cys-C:r=-0. 355,P=0. 006;β_2-MG:r=-0. 471,P=0. 000),差异均有统计学意义。结论通过检验OS患者血清Cys-C和β_2-MG水平可以监测早期肾损伤程度,并且Cys-C和β_2-MG水平和缺氧密切相关。
Objective To investigate early renal injury in overlap syndrome( OS) and related indicators. Methods Enrolled inthe study were 16 patients with OS( OS group) and 42 with chronic obstructive pulmonary disease( COPD; COPD group) treated inthe Department of Respiratory and Critical Care Medicine of Nanjing First Hospital from January 2014 to August 2018. During the sameperiod,30 healthy people without hypoxic diseases were enrolled as control group. Measurement was made of the pulmonary indicators[percentage of predicted forced expiratory volume in 1 second( FEV1%),percentage of predicted forced vital capacity( FVC%),forced expiratory volume in 1 second/forced vital capacity( FEV1/FVC) ],blood gas analysis [partial pressure of oxygen( PaO_2) andpartial pressure of carbon dioxide( PaCO_2) ],indicators of renal function [blood urea nitrogen( BUN),serum creatinine( SCr),endogenous creatinine clearance rate( Ccr),cystatin C( Cys-C) and β_2-microglobulin( β_2-MG) ]. The difference of the parameters a-mong groups was observed. SPSS statistics 22.0 was used for statistical analysis. According to the data type,analysis of variance( ANO-VA),LSD pairwise comparison or χ~2 test was used for comparison among groups,and Spearman rank correlation for the correlation be-tween Cys-C or β_2-MG and other indicators. Results The OS and COPD groups scored significantly higher than the control group inCOPD assessment test( CAT),PaCO_2,Cys-C and β_2-MG but significantly lower in PaO_2,FEV1%,FVC% and FEV1/FVC( P<0.05),but there were no significant differences in BUN,SCr and Ccr among the three groups( P > 0. 05). Compared with the COPDgroup,CAT,Cys-C and β_2-MG in the OS group were significantly higher( P< 0.05). The correlation analysis showed that Cys-C andβ_2-MG were positively correlated with CAT score( Cys-C: r = 0.722,P = 0.000; β_2-MG: r = 0.287,P = 0.029) and negatively correlatedwith PaO_2( Cys-C: r=-0.355,P= 0.006; β_2-MG: r =-0.471,P = 0.000),all with statistical significance( P<0.05).Conclusion Measurement of serum Cys-C and β_2-MG in OS patients can help monitor the degree of early renal injury,and Cys-C andβ_2-MG are closely associated with hypoxia.
Objective To investigate early renal injury in overlap syndrome( OS) and related indicators. Methods Enrolled inthe study were 16 patients with OS( OS group) and 42 with chronic obstructive pulmonary disease( COPD; COPD group) treated inthe Department of Respiratory and Critical Care Medicine of Nanjing First Hospital from January 2014 to August 2018. During the sameperiod,30 healthy people without hypoxic diseases were enrolled as control group. Measurement was made of the pulmonary indicators[percentage of predicted forced expiratory volume in 1 second( FEV1%),percentage of predicted forced vital capacity( FVC%),forced expiratory volume in 1 second/forced vital capacity( FEV1/FVC) ],blood gas analysis [partial pressure of oxygen( PaO_2) andpartial pressure of carbon dioxide( PaCO_2) ],indicators of renal function [blood urea nitrogen( BUN),serum creatinine( SCr),endogenous creatinine clearance rate( Ccr),cystatin C( Cys-C) and β_2-microglobulin( β_2-MG) ]. The difference of the parameters a-mong groups was observed. SPSS statistics 22.0 was used for statistical analysis. According to the data type,analysis of variance( ANO-VA),LSD pairwise comparison or χ~2 test was used for comparison among groups,and Spearman rank correlation for the correlation be-tween Cys-C or β_2-MG and other indicators. Results The OS and COPD groups scored significantly higher than the control group inCOPD assessment test( CAT),PaCO_2,Cys-C and β_2-MG but significantly lower in PaO_2,FEV1%,FVC% and FEV1/FVC( P<0.05),but there were no significant differences in BUN,SCr and Ccr among the three groups( P > 0. 05). Compared with the COPDgroup,CAT,Cys-C and β_2-MG in the OS group were significantly higher( P< 0.05). The correlation analysis showed that Cys-C andβ_2-MG were positively correlated with CAT score( Cys-C: r = 0.722,P = 0.000; β_2-MG: r = 0.287,P = 0.029) and negatively correlatedwith PaO_2( Cys-C: r=-0.355,P= 0.006; β_2-MG: r =-0.471,P = 0.000),all with statistical significance( P<0.05).Conclusion Measurement of serum Cys-C and β_2-MG in OS patients can help monitor the degree of early renal injury,and Cys-C andβ_2-MG are closely associated with hypoxia.
引文
[1]蔡柏蔷.应重视慢性阻塞性肺疾病的合并症问题[J].中华结核和呼吸杂志,2013,36(4):245-247. DOI:10.3724/SP.J.1264.2014.00023.Cai BQ. Attention should be paid to the complication of chronicobstructive pulmonary disease[J]. Chin J Tuberc Respir Dis,2013,36(4):245-247. DOI:10.3724/SP.J.1264.2014.00023.
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[5]王聪,谭进,陈宝元,等.间歇低氧暴露对大鼠肾小管上皮细胞损伤及白噬的影响[J].中华医学杂志,2018,98(12):935-938. DOI:10 3760/cma.J.issn.0376-2491.2018.12.012.Wang C,Tan J,Chen BY,et al. Effects of intermittent hypoxiaexposure on renal tubular epithelial cell injury and autophagy inrats[J]. Natl Med J China,2018,98(12):935-938. DOI:103760/cma.j.issn.0376-2491.2018.12.012.
[6]谢庆云,张满,黎凤珍. COPD合并早期肾功能损害患者血清cystatin C、Hcy、CRP含量变化及相关性分析[J].内科,2016,11(4):533-535. DOI:10. 16121. j. cnki. cn45-1347/r. 2016.04.08.Xie QY,Zhang M,Li FZ. Variation of serum cystatin C,Hcy andCRP in patients with COPD complicated with early renalimpairment and the correlation analysis[J]. Intern Med China,2016,11(4):533-535. DOI:10. 16121/j. cnki. cn45-1347/r.2016.04.08.
[7]朱宏霞,姜书宁,王媛.阻塞性睡眠呼吸暂停综合征患者肾脏早期损害的观察[J].肾脏病与透析肾移植杂志,2016,25(1):20-24. DOI:10. 3969/cndt. j. issn. 1006-298X. 2016.01.004.Zhu HX,Jiang SN,Wang Y. Observation of early renal damage inpatients with obstructive sleep apnea syndrome[J]. Chin J NephrolDial Transplant,2016,25(1):20-24. DOI:10. 3969/cndt. j.issn.1006-298X.2016.01.004.
[8]中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版)[J].中华结核和呼吸杂志,2013,36(4):1-10. DOI:10.3760/cma. j. issn.1001-0939.2013.04.007.Group of Chronic Obstructive Pulmonary Disease, RespiratoryDiseases Branch of Chinese Medical Association. Diagnosis andTreatment Guidelines of Chronic Obstructive Pulmonary Disease(2013 revised edition)[J]. Chin J Tuberc Respir Dis,2013,36(4):1-10. DOI:10.3760/cma.j.issn.1001-0939.2013.04.007.
[9]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].中华结核和呼吸杂志,2012,35(1):9-12. DOI:10.3760/cma.j.issn.1001-0939.2012.01.007.Group of Sleep Disorders,Respiratory Diseases Branch of ChineseMedical Association. Diagnosis and Treatment Guidelines ofObstructive Sleep Apnea Hypopnea Syndrome(2011 revisededition)[J]. Chin J Tuberc Respir Dis,2012,35(1):9-12.DOI:10.3760/cma.j.issn.1001-0939.2012.01.007.
[10] Jones PW,Harding G,Berry P,et al. Development and first vali-dation of the COPD assessment test[J]. Eur Respir J,2009,34(3):648-654. DOI:10.1183/09031936.00102509.
[11] Vogelmeier CF,Criner GJ,Martinez FJ,et al. Global strategy forthe diagnosis,management,and prevention of chronic obstructivelung disease(2017 report):GOLD executive summary[J]. ArchBronconeumol,2017,53(3):128-149. DOI:10. 1016/j. arbres.2017.02.001.
[12] Gjerde B,Bakke PS,Ueland T,et al. The prevalence of undiag-nosed renal failure in a cohort of COPD patients in WesternNorway[J]. Respir Med,2012,106(3):361-366. DOI:10.1016/j.rmed.2011.10.004.
[13] Yoshizawa T,Okada K,Furuichi S,et al. Prevalence of chronickidney diseases in patients with chronic obstructive pulmonarydisease:assessment based on glomerular filtration rate estimatedfrom creatinine and cystatin C levels[J]. Int J Chron ObstructPulmon Dis,2015,10:1283-1289. DOI:10.2147/COPD.S80673.
[14] Molnar MZ,Mucsi I,Novak M,et al. Association of incidentobstructive sleep apnoea with outcomes in a large cohort of USVeterans[J]. Thorax,2015,70(9):888-895. DOI:10. 1136/thoraxjnl-2015-206970.
[15] Lee YC,Hung SY,Wang HK,et al. Sleep apnea and the risk ofchronic kidney disease:a nationwide population-based cohortstudy[J]. Sleep,2015,38(2):213-221. DOI:10. 5665/sleep.4400.
[16] Marrone O,Battaglia S,Steiropoulos P,et al. Chronic kidneydisease in European patients with obstructive sleep apnea:theESADA cohort study[J]. J Sleep Res,2016,25(6):739-745.DOI:10.1111/jsr.12426.
[17] Lopez-Giacoman S, Madero M. Biomarkers in chronic kidneydisease,from kidney function to kidney damage[J]. World J Neph-rol,2015,4(1):57-73. DOI:10.5527/wjn.v4.i1.57.
[18] Narsingam S, Bozarth AL, Abdeljalil A. Updates in themanagement of stable chronic obstructive pulmonary disease[J].Postgrad Med, 2014, 127(7):758-770. DOI:10. 1080/00325481.2015.1084212.
[19]罗红艳,高永才,曹丽,等.老年慢性阻塞性肺疾病早期肾损伤相关因素探讨[J].中华老年多器官疾病杂志,2014,13(2):99-103. DOI:10.3724/SP.J.1264.2014.00023.Luo HY,Gao YC,Cao L,et al. Related factors of early renal injuryin the elderly with chronic obstructive pulmonary disease[J]. ChinJ Mult Organ Dis Elderly,2014,13(2):99-103. DOI:10.3724/SP.J.1264.2014.00023.
[20]庞志刚,成孟瑜,许建英.血清胱抑素C与稳定期慢性阻塞性肺疾病患者疾病严重程度相关性分析[J].中华肺部疾病杂志(电子版),2017,10(6):668-672. DOI:10.3877/cma.j.issn.1674-6902.2017.06.007.Pang ZG,Cheng MY,Xu JY. Correlative analysis of the level of se-rum cystatin C in different severity of patients with stable chronicobstructive pulmonary disease[J]. Chin J Lung Dis(Electron Ed),2017,10(6):668-672. DOI:10. 3877/cma. j. issn. 1674-6902.2017.06.007.
[21]钟红珍,钟志青,周添标.低氧诱导因子1α在肾脏病中的研究进展[J].实用医学杂志,2018,34(14):2444-2448. DOI:10.3969/j.issn.1006-5725.2018.14.040.Zhong HZ,Zhong ZQ,Zhou TB. Research progress of hypoxiainducible factor 1 alpha in kidney disease[J]. J Pract Med,2018,34(14):2444-2448. DOI:10. 3969/j. issn. 1006-5725. 2018.14.040.
[22] Archontogeorgis K,Nena E,Tsigalou C,et al. Cystatin C levels inmiddle-aged patients with obstructive sleep apnea syndrome[J].Pulm Med,2016,2016:8081723. DOI:10.1155/2016/8081723.
[23]赵素芝,栾兴伟,张花蕾.老年COPD患者早期肾损伤检测的临床价值及意义[J].中国老年保健医学,2016,14(3):29-31.DOI:10.3969/j.issn.1672-4860.2016.03.013.Zhao SZ,Luan XW,Zhang HL. Clinical value and significance toinspect early renal injury in elderly patients with COPD[J]. Chin JGeriatric Care,2016,14(3):29-31. DOI:10.3969/j.issn.1672-4860.2016.03.013.
[24]肖亚军,王宋平.慢性阻塞性肺疾病相关性肾损伤机制的研究进展[J].实用医学杂志,2015,31(21):3618-3620. DOI:10.3969/j.issn.1006-5725.2015.21.051.Xiao YJ,Wang SP. Research progress on mechanism of chronicobstructive pulmory disease-related renal injury[J]. J Pract Med,2015,31(21):3618-3620. DOI:10. 3969/j. issn. 1006-5725.2015.21.051.
[2] Ayas NT,Hirseh AA,Laher I,et al. New frontiers in obstructivesleep apnoea[J]. Clin Sci(Lond),2014,127(4):209-216.DOI:10.1042/CS20140070.
[3] Petrone A,Fimognari FL,Mormile F,et al. The respiratory“overlapsyndrome”:efficacy and usefulness of the combined double bron-chodilation[J]. Respiration,2018,95(Suppl 1):15-18. DOI:10.1159/000487179.
[4] Borukhov I,Rizzolo D. Overlap syndrome:obstructive sleep apneaand chronic obstructive pulmonary disease[J]. JAAPA,2016,29(11):18-22. DOI:10.1097/01.JAA.0000502856.98104.9f.
[5]王聪,谭进,陈宝元,等.间歇低氧暴露对大鼠肾小管上皮细胞损伤及白噬的影响[J].中华医学杂志,2018,98(12):935-938. DOI:10 3760/cma.J.issn.0376-2491.2018.12.012.Wang C,Tan J,Chen BY,et al. Effects of intermittent hypoxiaexposure on renal tubular epithelial cell injury and autophagy inrats[J]. Natl Med J China,2018,98(12):935-938. DOI:103760/cma.j.issn.0376-2491.2018.12.012.
[6]谢庆云,张满,黎凤珍. COPD合并早期肾功能损害患者血清cystatin C、Hcy、CRP含量变化及相关性分析[J].内科,2016,11(4):533-535. DOI:10. 16121. j. cnki. cn45-1347/r. 2016.04.08.Xie QY,Zhang M,Li FZ. Variation of serum cystatin C,Hcy andCRP in patients with COPD complicated with early renalimpairment and the correlation analysis[J]. Intern Med China,2016,11(4):533-535. DOI:10. 16121/j. cnki. cn45-1347/r.2016.04.08.
[7]朱宏霞,姜书宁,王媛.阻塞性睡眠呼吸暂停综合征患者肾脏早期损害的观察[J].肾脏病与透析肾移植杂志,2016,25(1):20-24. DOI:10. 3969/cndt. j. issn. 1006-298X. 2016.01.004.Zhu HX,Jiang SN,Wang Y. Observation of early renal damage inpatients with obstructive sleep apnea syndrome[J]. Chin J NephrolDial Transplant,2016,25(1):20-24. DOI:10. 3969/cndt. j.issn.1006-298X.2016.01.004.
[8]中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版)[J].中华结核和呼吸杂志,2013,36(4):1-10. DOI:10.3760/cma. j. issn.1001-0939.2013.04.007.Group of Chronic Obstructive Pulmonary Disease, RespiratoryDiseases Branch of Chinese Medical Association. Diagnosis andTreatment Guidelines of Chronic Obstructive Pulmonary Disease(2013 revised edition)[J]. Chin J Tuberc Respir Dis,2013,36(4):1-10. DOI:10.3760/cma.j.issn.1001-0939.2013.04.007.
[9]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].中华结核和呼吸杂志,2012,35(1):9-12. DOI:10.3760/cma.j.issn.1001-0939.2012.01.007.Group of Sleep Disorders,Respiratory Diseases Branch of ChineseMedical Association. Diagnosis and Treatment Guidelines ofObstructive Sleep Apnea Hypopnea Syndrome(2011 revisededition)[J]. Chin J Tuberc Respir Dis,2012,35(1):9-12.DOI:10.3760/cma.j.issn.1001-0939.2012.01.007.
[10] Jones PW,Harding G,Berry P,et al. Development and first vali-dation of the COPD assessment test[J]. Eur Respir J,2009,34(3):648-654. DOI:10.1183/09031936.00102509.
[11] Vogelmeier CF,Criner GJ,Martinez FJ,et al. Global strategy forthe diagnosis,management,and prevention of chronic obstructivelung disease(2017 report):GOLD executive summary[J]. ArchBronconeumol,2017,53(3):128-149. DOI:10. 1016/j. arbres.2017.02.001.
[12] Gjerde B,Bakke PS,Ueland T,et al. The prevalence of undiag-nosed renal failure in a cohort of COPD patients in WesternNorway[J]. Respir Med,2012,106(3):361-366. DOI:10.1016/j.rmed.2011.10.004.
[13] Yoshizawa T,Okada K,Furuichi S,et al. Prevalence of chronickidney diseases in patients with chronic obstructive pulmonarydisease:assessment based on glomerular filtration rate estimatedfrom creatinine and cystatin C levels[J]. Int J Chron ObstructPulmon Dis,2015,10:1283-1289. DOI:10.2147/COPD.S80673.
[14] Molnar MZ,Mucsi I,Novak M,et al. Association of incidentobstructive sleep apnoea with outcomes in a large cohort of USVeterans[J]. Thorax,2015,70(9):888-895. DOI:10. 1136/thoraxjnl-2015-206970.
[15] Lee YC,Hung SY,Wang HK,et al. Sleep apnea and the risk ofchronic kidney disease:a nationwide population-based cohortstudy[J]. Sleep,2015,38(2):213-221. DOI:10. 5665/sleep.4400.
[16] Marrone O,Battaglia S,Steiropoulos P,et al. Chronic kidneydisease in European patients with obstructive sleep apnea:theESADA cohort study[J]. J Sleep Res,2016,25(6):739-745.DOI:10.1111/jsr.12426.
[17] Lopez-Giacoman S, Madero M. Biomarkers in chronic kidneydisease,from kidney function to kidney damage[J]. World J Neph-rol,2015,4(1):57-73. DOI:10.5527/wjn.v4.i1.57.
[18] Narsingam S, Bozarth AL, Abdeljalil A. Updates in themanagement of stable chronic obstructive pulmonary disease[J].Postgrad Med, 2014, 127(7):758-770. DOI:10. 1080/00325481.2015.1084212.
[19]罗红艳,高永才,曹丽,等.老年慢性阻塞性肺疾病早期肾损伤相关因素探讨[J].中华老年多器官疾病杂志,2014,13(2):99-103. DOI:10.3724/SP.J.1264.2014.00023.Luo HY,Gao YC,Cao L,et al. Related factors of early renal injuryin the elderly with chronic obstructive pulmonary disease[J]. ChinJ Mult Organ Dis Elderly,2014,13(2):99-103. DOI:10.3724/SP.J.1264.2014.00023.
[20]庞志刚,成孟瑜,许建英.血清胱抑素C与稳定期慢性阻塞性肺疾病患者疾病严重程度相关性分析[J].中华肺部疾病杂志(电子版),2017,10(6):668-672. DOI:10.3877/cma.j.issn.1674-6902.2017.06.007.Pang ZG,Cheng MY,Xu JY. Correlative analysis of the level of se-rum cystatin C in different severity of patients with stable chronicobstructive pulmonary disease[J]. Chin J Lung Dis(Electron Ed),2017,10(6):668-672. DOI:10. 3877/cma. j. issn. 1674-6902.2017.06.007.
[21]钟红珍,钟志青,周添标.低氧诱导因子1α在肾脏病中的研究进展[J].实用医学杂志,2018,34(14):2444-2448. DOI:10.3969/j.issn.1006-5725.2018.14.040.Zhong HZ,Zhong ZQ,Zhou TB. Research progress of hypoxiainducible factor 1 alpha in kidney disease[J]. J Pract Med,2018,34(14):2444-2448. DOI:10. 3969/j. issn. 1006-5725. 2018.14.040.
[22] Archontogeorgis K,Nena E,Tsigalou C,et al. Cystatin C levels inmiddle-aged patients with obstructive sleep apnea syndrome[J].Pulm Med,2016,2016:8081723. DOI:10.1155/2016/8081723.
[23]赵素芝,栾兴伟,张花蕾.老年COPD患者早期肾损伤检测的临床价值及意义[J].中国老年保健医学,2016,14(3):29-31.DOI:10.3969/j.issn.1672-4860.2016.03.013.Zhao SZ,Luan XW,Zhang HL. Clinical value and significance toinspect early renal injury in elderly patients with COPD[J]. Chin JGeriatric Care,2016,14(3):29-31. DOI:10.3969/j.issn.1672-4860.2016.03.013.
[24]肖亚军,王宋平.慢性阻塞性肺疾病相关性肾损伤机制的研究进展[J].实用医学杂志,2015,31(21):3618-3620. DOI:10.3969/j.issn.1006-5725.2015.21.051.Xiao YJ,Wang SP. Research progress on mechanism of chronicobstructive pulmory disease-related renal injury[J]. J Pract Med,2015,31(21):3618-3620. DOI:10. 3969/j. issn. 1006-5725.2015.21.051.