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  

Diagnostic values of serum cystatin C and serial urinary enzymes in early renal damage of obstructive sleep apnea hypopnea syndrome

作　　者：余勤[1] 汪小亚[1] 岳红梅[1] 张佳宾[1] 阳书坤[1] 

机构地区：[1]兰州大学第一医院呼吸科,甘肃兰州730000

出　　处：《兰州大学学报（医学版）》2008年第1期13-16,共4页Journal of Lanzhou University（Medical Sciences）

基　　金：兰州大学医学科研基金(LZUYX200647)资助项目

摘　　要：目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者早期肾功能损害敏感指标血清胱蛋白酶抑制剂C(Cystatin C)的水平及尿系列酶活性的相关变化。方法选择经多导睡眠仪监测确诊的46例OSAHS患者(OSAHS组)和健康自愿者30例(对照组),采用ELISA法测定血清Cystatin C水平;采用底物速率法检测尿系列酶[N-乙酰-β-D-氨基葡萄糖苷酶(NAG)、β-半乳糖苷酶、γ-谷氨酰转移酶(GGT)和碱性磷酸酶]的活性。结果OSAHS组血清Cystatin C水平显著高于对照组(P<0.01),尿系列酶活性较对照组升高(P<0.01或P<0.05)。OSAHS组与对照组相比较常规肾功能指标差异无显著性(P>0.05)。OSAHS组血清Cystatin C水平与呼吸暂停低通气指数(AHI)呈正相关(r=0.495,P<0.05),与平均血氧饱和度和最低血氧饱和度呈负相关(r分别为-0.476、-0.465,P<0.001);NAG和GGT与AHI呈正相关(r分别为0.510、0.495,P<0.001),而与平均血氧饱和度和最低血氧饱和度呈负相关(r分别为-0.453、-0.428和-0.501、-0.480,P<0.05)。结论OSAHS患者肾功能损害指标血清Cystatin C水平及尿系列酶活性显著升高,提示OSAHS患者存在肾功能损害,且血清Cystatin C水平及尿系列酶活性变化早于常规肾功能指标的变化。血清Cystatin C水平及尿系列酶活性是监测OSAHS患者早期肾功能损害的敏感指标。Objective To study the diagnostic values of serum cystatin C and serial urinary enzymes in early renal damage of obstructive sleep apnea hypopnea syndrome （OSAHS）. Methods 46 patients with OSAHS （OSAHS group） and 30 normal controls （control group） were selected by polysomnography （PSG） test. The level of serum cystatin C was detected by ELISA, and serial urinary enzymes [N-acetylglucosaminidase （NAG）, galactosidae （GAL）, γ-glutamyltransferase （GGT）, alkaline phosphatase（ALP）] were detected by rate assay. Results The level of serum cystatin C in OSAHS group was significantly higher than that in control group （P 〈0.01）. In patients with OSAHS, the levels of NAG, GAL, GGT and ALP were significantly higher than those in control group （P 〈0.01 or P 〈0.05）. There was no difference in conventional renal functions between OSAHS group and control group （P 〉0.05）. In patients with OSAHS, the level of serum cystatin C was positively correlated with apnea hyponea index （AHI, r=0.495, P 〈 0.001）, which was negatively correlated with mean SaO2 （MSaO2, r=-0.476, P 〈 0.001） or the lowest SaO2 （LSaO2, r=-0.465, P 〈 0.001）. The level of NAG （r=0.510, P 〈 0.001） or GGT （r=0.495, P 〈 0.001）was positively correlated with AHI, which was negatively correlated with MSaO2 or LSaO2 （P 〈0.05）. Conclusion The levels of serum cystatin C and serial urinary enzymes are significantly increased in patients with renal damages, and their changes are earlier than those of conventional renal functions. They may be used as sensitive indicators for monitoring early renal damage in patients with OSAHS.

关 键 词：阻塞性睡眠呼吸暂停低通气综合征 胱蛋白酶抑制剂C 尿系列酶 肾功能 

分 类 号：R567[医药卫生—呼吸系统]