2型糖尿病合并阻塞性睡眠呼吸暂停综合征患者肾脏并发症患病情况及相关因素分析  

Analysis of Renal Complication and Its Relative Factors in Patients with Type 2 Diabetes Mellitus Combined with Obstructive Sleep Apnea Syndrome

作　　者：刘然[1] 张雷 李春林[3] 侯艳微[1] 方毅[1] 王津京[1] 曾静[1] 刘慧莹 郭庆玲[1] 

机构地区：[1]解放军307医院内分泌科,北京100071 [2]火箭军总医院急诊科,北京100088 [3]解放军316医院干部病房,北京100093 [4]解放军307医院呼吸内科,100071

出　　处：《标记免疫分析与临床》2017年第5期495-498,共4页Labeled Immunoassays and Clinical Medicine

基　　金：首都卫生发展科技专项研究(编号:首发2014-4-5063)

摘　　要：目的研究住院2型糖尿病合并阻塞性睡眠呼吸暂停征(OSAS)患者肾脏合并症情况。方法收集符合条件的2型糖尿病患者,记录年龄、病程、体重指数、腰围、血压等指标,使用便携式睡眠呼吸监测仪进行睡眠呼吸监测,同时完善糖化血红蛋白、空腹血糖、餐后2小时血糖、肌酐、尿素氮、24小时尿微量白蛋白及尿蛋白检验,并计算肾小球滤过率。结果完成研究106例,71例合并OSAS。合并OSAS的患者肌酐(64.49±15.72μmol/L vs 57.28±8.69μmol/L,P<0.05)、尿素氮(5.04±0.61mmol/L vs 4.71±0.64mmol/L,P<0.05)、24小时尿微量白蛋白[25.30(12.64,68.70)mg vs 8.74(4.8,16.24)mg,P<0.05]及24小时尿蛋白[0.24(0.1,1.45)g vs 0.15(0.06,0.26)g,P<0.05]高于未合并OSAS患者,合并OSAS患者肾小球滤过率(89.83±13.97mL·min^(-1)·1.73m^(-2)vs 102.88±8.02mL·min^(-1)·1.73m^(-2),P<0.05)偏低。合并OSAS的患者中,出现Ⅲ期以上糖尿病肾病比未合并OSAS的患者更多见(53.5%vs46.5%,P<0.05)。采用多因素logistics回归分析后发现,糖化血红蛋白(OR1.36,95%CI 1.01~1.07,P<0.05),空腹血糖(OR1.01,95%CI0.73~1.16,P<0.05)及每小时睡眠呼吸暂停次数(AHI)(OR 1.1 1,95%CI 1.00~1.23,P<0.05)与Ⅲ期以上糖尿病肾病患病独立相关。结论合并OSAS的2型糖尿病患者肾脏功能下降更明显,更容易出现肾脏并发症,OSAS是糖尿病肾脏病变的独立危险因素。Objective To inspect the incidence and severity of the renal complication in type 2 diabetes mellitus inpatients complicated with obstructive sleep apnea syndrome （OSAS）. Methods Eligible inpatients with type 2 diabetes were selected and monitored by ResMedApneaLinkTM Plus portable sleep testing device. Patients＇ disease course information and baseline parameters including body mass index （BMI）, waist circumference and blood pressure were recorded. Patients＇ blood samples were collected for laboratory tests of Hemoglobin Alc （HbAlc）, fasting blood glucose （FBG）, 2- hour postprandial blood glucose, creatinine （Cr）, blood urea nitrogen （BUN） and urine samples for 24-hour microalbuminuria and urine protein tests. Estimated glomerular filtration rate （eGFR） were also calculated respectively. Results 106 patients were performed with all tests, 71 of which were combined with OSAS. OSAS patients had higher levels of creatinine（64.49 ± 15.72 μmol/L vs 57.28 ± 8.69μmol/L,P 〈 0.05）, BUN（5.04 ±0. 61mmol/L vs 4.71 ±0.64mmol/L,P 〈 0.05 ）, 24- hour microalbuminuria [ 25.30 （ 12.64,68.70）mg vs 8.74（94.8,16.24）mg,P 〈0.05], 24-hour urine proteinEO. 24 （0. 1,1.45）g vs 0.15 （0.06,0.26）g, P 〈0.05] ; but lower eGFR（89.83 ± 13.97mL · min-1· 1.73m-2vs 102.88.02mL · min-1· 1.73m-2,P 〈0.05） than non-OSAS patients. More cases were at phase Ⅲ-Ⅴ diabetic nephropathy in OSAS group than those in nonOSAS group（53.5% vs 46. 5% ,P 〈 0. 05）. Multivariate logistics regression analysis revealed that HbAlc（ OR 1.36, 95%CI 1.01-1.07,P 〈0.05）, FBG（OR 1.01, 95%CI 0. 73-1.16,P 〈0.05） and apnea-hypopnea index （AHI）（OR 1. 11, 95% CI 1.00-1.23,P 〈0.05） wereindependently relevant to the incidence of phase Ⅲ-Ⅴ diabetic nephropathy. Conclusion Patients with type 2 diabetes mellitus in combination with OSAS are susceptible to severe renal complication, and OSAS is an independent risk factor to diabetic nephropathy.

关 键 词：睡眠呼吸暂停 阻塞性 2型糖尿病 肾脏并发症 

分 类 号：R587.2[医药卫生—内分泌] R692.9[医药卫生—内科学] R766[医药卫生—临床医学]