阻塞性睡眠呼吸暂停低通气综合征对2型糖尿病肾病的影响  

Influence of obstructive sleep apnea-hypopnea syndrome on type 2 diabetic nephropathy

作　　者：张伟欣[1] 刘静[2] 安思芹[3] 张琦[3] 牛瑞兰[3] 郑鹏[3] 

机构地区：[1]宁夏医科大学临床学院,宁夏银川750004 [2]甘肃省人民医院内分泌科,甘肃兰州730000 [3]兰州大学第一临床医学院,甘肃兰州730000

出　　处：《兰州大学学报（医学版）》2014年第2期47-50,54,共5页Journal of Lanzhou University（Medical Sciences）

摘　　要：目的观察分析阻塞性睡眠呼吸暂停低通气综合征(OSAHS)对2型糖尿病肾病(DN)的影响。方法在2型糖尿病住院患者中使用便携式睡眠呼吸监测仪检测呼吸暂停低通气指数(AHI)、氧减饱和度指数(ODI)和夜间最低血氧饱和度(LSaO2),记录患者一般临床资料,检测糖化血红蛋白Alc(HbAlc)、24 h尿微量白蛋白(mAlb)。根据诊断标准将患者分为单纯糖尿病组(60例)、轻度OSAHS组(39例)和中重度OSAHS组(41例),分析3组间相关临床资料;采用偏相关分析方法观察mAlb与OSAHS指标的相关性;根据是否合并DN将患者分为DN组(44例)与无DN组(96例),对比分析两组间相关临床资料;采用多因素logistic回归分析方法对DN的影响因素进行分析。结果中重度OSAHS组体重指数高于单纯糖尿病组和轻度OSAHS组(P<0.05),中重度OSAHS组患者DN患病率高于单纯糖尿病组(P<0.05)。mAlb与AHI(r=0.31)、ODI(r=0.42)呈正相关(P<0.05),与LSaO2无相关性。与无DN组相比,DN组患者平均年龄更大,糖尿病病程更长,HbAlc和ODI更高(P<0.05),两组间AHI、LSaO2、体重指数差别无统计学意义。多因素logistic回归显示HbAlc、ODI、糖尿病病程与DN独立相关(P<0.05)。结论OSAHS能够加重2型糖尿病患者肾功能损害,ODI是DN的独立危险因素。Objective To analyse the influence of obstructive sleep apnea-hypopnea syndrome（OSAHS） on type 2 diabetic nephropathy（DN）.Methods The hospitalized patients with type2 diabetes mellitus（T2DM） were screened for OSAHS.Portable sleep respiration monitor was used to detect apnea hypopnea index（AHI）,oxygen desaturation index（ODI） and lowest oxygen saturation（LSaO2）.All patients＇ general clinical data,hemoglobin A1C（HbA1c）,24 h urine microalbuminuria（mAlb） were recorded and analyzed.According to the diagnostic criteria,patients were divided into simple T2 DM group（n=60）,mild OSAHS group（n=39） and moderate-to-severe OSAHS group（n=41）,and their clinical data were compared for 3 groups.The relations between mAlb and OSAHS indexes were investigated by partial correlation analysis.According to whether they had DN or not,the patients were divided into DN group（n=44） and non DN group（n=96）,and their clinical data were also compared and analyzed.Influencing factors of DN were analyzed by multiple logistic regression analysis either.Results The body mass index was significantly higher in moderate-to-severe OSAHS group than in simply T2 DM group and mild OSAHS group,and the prevalence of DN was higher in moderate-to-severe OSAHS group than in simply T2 DM group.The mAlb was positively related to AHI（r=0.31） and ODI（r=0.42,P〈 0.05）,but had no significant correlation with LSa02.Compared with the non DN patients,the age of the DN patients were older and their diabetes duration were longer（P 〈0.05）.Their HbAlc and ODI were significantly higher（P〈0.05）,and there was no significant difference between the two groups in AHI,LSaO2 and body mass index.Multivariate logistic regression analysis revealed that HbAlc,ODI and diabetes duration were independently correlated with DN（P〈 0.05）.Conclusion OSAHS aggravates renal damages in patients with T2 DM,and ODI is a independent risk factor for DN.

关 键 词：2型糖尿病 阻塞性睡眠呼吸暂停低通气综合征 糖尿病肾病 

分 类 号：R587.2[医药卫生—内分泌]