阻塞性睡眠呼吸暂停低通气综合征肾功能损害的危险因素研究

发布时间：2018-04-19 20:07

本文选题：阻塞性睡眠呼吸暂停低通气综合征 + 慢性肾功能不全　；参考：《郑州大学》2017年硕士论文

【摘要】：背景与目的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)是一种常见的呼吸系统疾病,其特点为反复出现的上气道塌陷,导致的低氧血症及睡眠呼吸暂停,并可造成全身多系统损害(包括肾功能损害)。国外多个描述性研究已经证实,OSAHS与慢性肾脏病之间存在关联,OSAHS会引起患者的肾功能损害,国外学者在一项研究中发现,OSAHS患者中CKD的患病率高达30.5%,且与睡眠呼吸暂停和夜间低氧血症有关。本研究以血清尿素氮、血清肌酐、血清胱抑素C浓度及e GFR为指标,探讨OSAHS患者是否存在肾功能损害及引起肾功能损害的危险因素,为临床OSAHS患者发展为CKD的防治提供依据。对象与方法收集2016年7月至2017年1月期间,在郑州大学第一附属医院老年呼吸睡眠科睡眠诊疗中心行多导睡眠监测(PSG)的患者175例,最终确诊为OSAHS的患者145例(OSAHS组)及健康患者33例(非OSAHS组),排除患有糖尿病、高血压、高脂血症及有急性肾功能不全、肾小球疾病、泌尿系感染等疾病的患者。经问卷调查、体格检查及至少7小时的PSG监测,监测并详细记录患者的性别、年龄、身高、体重、颈围、腰围、体重指数(BMI)、AHI、最低Sa O_2(La SO_2)、SaO_2低于90%时间占总睡眠时间百分比(CT90%)、血清胱抑素C、血清肌酐、血清尿素氮、肾小球滤过率、空腹血糖、胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白及血压等指标,应用SPSS 22.0软件,根据研究变量不同,采用t检验、卡方检验、秩和检验分别对OSAHS组和非OSAHS组进行分析,然后对OSAHS组患者的血清尿素氮、血清胱抑素C浓度及肾小球滤过率(e GFR)与影响肾功能损害的各危险因素进行Pearson相关分析,并以血清尿素氮、血清胱抑素C浓度及肾小球滤过率(e GFR)为结局变量进行多重线性回归分析(P0.05)。结果1 145例OSAHS患者中发生肾功能损害的患者占21.8%,其中6.9%的患者为中重度肾功能损害。2两组间比较发现,e GFR:OSAHS组(?)±s为(103.490±27.260)ml/min·1.73m~2,非OSAHS组为(115.355±27.630)ml/min·1.73m~2,差异有统计学意义(t=-2.251,P=0.026);Cys C:OSAHS组(?)±s为(0.979±0.377)mg/L,非OSAHS组(0.830±0.115)mg/L,差异有统计学意义(t=2.239,P=0.026);BUN:OSAHS组(?)±s为(5.519±1.859)mmol/L,非OSAHS组(4.750±0.896)mmol/L,差异有统计学意义(t=2.312,P=0.022);年龄:OSAHS组(?)±s为(50.060±11.112)岁,非OSAHS组(43.090±12.546)岁,差异有统计学意义(t=3.171,P=0.002);体重:OSAHS组(?)±s为(83.266±13.460)Kg,非OSAHS组为(72.091±9.221)Kg,差异有统计学意义(t=4.529,P=0.000);BMI:OSAHS组(?)±s为(28.894±4.010)Kg/m~2,非OSAHS组(?)±s为(25.401±3.103)Kg/m~2,差异有统计学意义(t=4.690,P=0.000);颈围:OSAHS组(?)±s为(41.430±2.728)cm,非OSAHS组(?)±s为(38.970±2.756)cm,差异有统计学意义(t=4.663,P=0.000);腰围:OSAHS组(?)±s为(102.940±9.129)cm,非OSAHS组(?)±s为(95.210±8.517)cm,差异有统计学意义(t=4.44,P=0.000);LSa O_2:OSAHS组(?)±s为(73.840±11.178)%,非OSAHS组(?)±s为(89.880±4.136)%,差异有统计学意义(t=-8.102,P=0.000);CT90%:OSAHS组(?)±s为(16.950±19.693)%,非OSAHS组(?)±s为(0.250±0.675)%,差异有统计学意义(t=4.861,P=0.000);最长呼吸暂停时间:OSAHS组(?)±s为(62.041±27.491)s,非OSAHS组为(26.279±16.904)s,差异有统计学意义(t=7.162,P=0.000)。而性别、身高、血清肌酐、血糖、SBP、DBP、T-CHO、TG、HDL及LDL在两组间差异均无统计学意义(P均0.005)。3采用单因素方差分析BUN、SCr、Cys C、e GFR在轻、中、重度OSAHS患者中的组间差异发现,e GFR:轻度OSAHS组±s为(111.605±20.893)ml/min·1.73m~2,中度OSAHS组为(82.947±28.443)ml/min·1.73m~2,重度OSAHS组为(82.947±28.443)ml/min·1.73m~2,差异有统计学意义(P=0.028);Cys C:轻度OSAHS组±s为(0.824±0.118)mg/L,中度OSAHS组(1.008±0.255)mg/L,重度OSAHS组(1.043±0.441)mg/L,差异有统计学意义(P=0.041);BUN、SCr在三组间比较差异均无统计学意义(P均0.05)。4在OSAHS组中,应用Preason相关性检验分别分析e GFR、BUN、Cys C与影响肾功能损害的各危险因素的相关性,研究发现e GFR与年龄、BMI、CT90%呈负相关(r=-0.343,P=0.000;r=-0.207,P=0.012;r=-0.300,P=0.000);BUN与体重、颈围、CT90%呈正相关(r=0.166,P=0.045;r=0.194,P=0.019;r=0.255,P=0.002);Cys C与体重、BMI、颈围、腰围、AHI、CT90%、最长呼吸暂停时间呈正相关(r=0.353,P=0.000;r=0.333,P=0.000;r=0.193,P=0.020;r=0.206,P=0.013;r=0.366,P=0.000;r=0.582,P=0.000;r=0.202,P=0.015),与LSa O_2呈负相关(r=-0.296,P=0.000)。再分别以e GFR、BUN、Cys C为因变量,与肾功能损害相关的危险因素为自变量,采用多重线性回归分析各因素对e GFR、BUN、Cys C的影响,结果示:e GFR与年龄、BMI、CT90%相关(β=-0.947,P=0.000;β=-1.361,P=0.011;β=-32.639,P=0.001);Cys C与CT90%相关(β=0.576,P=0.000);BUN与CT90%相关(β=0.223,P=0.010)。结论1 OSAHS患者存在肾功能损害,且肾功能损害程度随着OSAHS程度的加重而加重。2血氧饱和度低于90%时间占总睡眠时间百分比是引起OSAHS患者肾功能损害的独立危险因素。3 e GFR、胱抑素C可以作为OSAHS患者早期肾功能损害的检测指标。
[Abstract]:BACKGROUND & OBJECTIVE To study the risk factors of renal function damage and renal function damage in patients with obstructive sleep apnea . There was significant difference in serum urea nitrogen , serum cystatin C concentration and glomerular filtration rate ( e GFR ) . The results showed that the serum urea nitrogen , serum cystatin C concentration and glomerular filtration rate ( e GFR ) were ( 3.490 卤 27.260 ) ml / min 路 1.73m ~ 2 , and the difference was statistically significant ( t = 2.239 , P = 0.000 ) . The difference was statistically significant ( t = 4.64 , P = 0.000 ) , and the difference was statistically significant ( t = 4.64 , P = 0.000 ) , while the difference was statistically significant ( t = 4.861 , P = 0.000 ) . There was no significant difference between the two groups ( P = 0.041 ) , the difference was ( 82.947 卤 28.443 ) ml / min 路 1.73m ~ 2 , and the difference was statistically significant ( P = 0.041 ) . There was a positive correlation between the levels of serum BUN and SCr ( r = - 0.207 , P = 0.012 ; r = - 0.300 , P = 0.000 ) ; BUN and body weight , neck circumference , CT90 % were positively correlated ( r = 0.166 , P = 0.045 ) . r = 0.194 , P = 0.019 ; r = 0.255 , P = 0.002 ) ; Cys C was positively correlated with body weight , BMI , neck circumference , waist circumference , ahi , CT90 % , longest apnea time ( r = 0.333 , P = 0.000 ; r = 0.582 , P = 0.000 ; r = 0.202 , P = 0.015 ) , negatively correlated with LSa O _ 2 ( r = - 0.296 , P = 0.000 ) . The effects of various factors on e GFR , BUN and Cys C were analyzed by multiple linear regression . The results showed that e GFR was correlated with age , BMI , CT90 % ( 尾 = - 0.947 , P = 0.000 ; 尾 = - 1.361 , P = 0 . 011 ; 尾 = - 32.639 , P = 0.001 ) ; Cys C was correlated with CT90 % ( 尾 = 0.576 , P = 0.000 ) ; BUN was correlated with CT90 % ( 尾 = 0.223 , P = 0.010 ) . Conclusion The degree of renal function damage in patients with obstructive sleep apnea is more than 90 % . The percentage of total sleep time is the independent risk factor which causes the renal function damage in patients with obstructive sleep apnea syndrome .

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R766;R692

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