2型糖尿病患者阻塞性睡眠呼吸暂停低通气综合征与肾功能之间的关系  

The relationship between obstructive sleep apnea hypopnea syndrome and renal function in patients with type 2 diabetes mellitus

作　　者：李红梅[1] 陈英华[1] 晏群[1] 李栩[1] 李惠芝[1] 冯波[1] 

机构地区：[1]上海同济大学附属东方医院内分泌科,200120

出　　处：《中华内分泌代谢杂志》2017年第7期552-555,共4页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的 观察2型糖尿病患者阻塞性睡眠呼吸暂停低通气综合征（OSAHS）是否影响肾功能.方法 连续收集2012年9月至2014年9月于上海市东方医院内分泌科住院的2型糖尿病患者298例,使用便携式睡眠呼吸监测仪评估睡眠呼吸暂停低通气指数（apnea hypopnea index,AHI）、氧减饱和度指数（oxygen desaturation index,ODI）和夜间最低血氧饱和度（lowest arterial oxygen saturation,LSaO2）,根据AHI〈5将患者分为单纯2型糖尿病组（120例）和2型糖尿病合并OSAHS组（178例）.根据估算的肾小球滤过率（eGFR）将2型糖尿病患者分为3组：eGFR〉90 ml·min-1·（1.73 m2）-1组（190例）,90〉eGFR〉60 ml·min-1·（1.73 m2）-1组（84例）和eGFR〈60 ml·min-1·（1.73 m2）-1组（24例）.采用logistic回归分析评估AHI和eGFR的影响因素.结果 2型糖尿病有无合并OSAHS组之间eGFR、血尿酸、高密度脂蛋白胆固醇（HDL-C）、腰围、臀围、体重指数（BMI）和尿微量白蛋白（microalbuminuria,mAlb）水平差异有统计学意义（均P〈0.05）.相关分析显示eGFR与AHI（r=-0.154,P=0.008）、ODI（r=-0.236,P〈0.01）、LSaO2（r=0.145,P=0.024）呈显著相关.Logistic回归分析显示,eGFR（OR=0.991,95%CI 0.983～0.998,P=0.014）、BMI（OR=1.107,95%CI 1.028～1.193,P=0.008）是AHI的独立危险因素.2型糖尿病不同eGFR水平组之间,年龄、mAlb、AHI、ODI、LSaO2存在明显差异（均P〈0.05）.线性逐步回归显示,年龄（β=-0.456,95%CI-0.571～-0.346,P〈0.01）、AHI（β=-0.119,95%CI-0.226～-0.007,P=0.037）与eGFR显著相关.结论 OSAHS是2型糖尿病患者肾功能损害的危险因素.Objective To observe the effect of obstructive sleep apnea hypopnea syndrome （OSAHS） on the renal function in patients with type 2 diabetes mellitus （T2DM）.Methods Sleep apnea hypopnea index （AHI）, oxygen desaturation index （ODI）, and nighttime lowest oxygen saturation （LSaO2） were evaluated in 298 patients with T2DM using a portable sleep apnea monitor.Patients were divided into T2DM without OSAHS group （n=120） and with OSAHS group （n=178） according to AHI〈5.Patients were divided into 3 groups according to estimated glomerular filtration rate （eGFR）： eGFR〉90 ml·min-1·（1.73 m2）-1 （n=190）, 90〉eGFR〉60 ml·min-1·（1.73 m2）-1 （n=84）, eGFR〈60 ml·min-1·（1.73 m2）-1 （n=24）.The influencing factors of eGFR and AHI were analyzed by logistic regression analysis.Results There were significant differences in eGFR, uric acid （UA）, high density lipoprotein-cholesterol （HDL-C）, waist circumference, hip circumference, body mass index （BMI）, and urinary albumin between T2DM without OSAHS and with OSAHS groups（all P〈0.05）.eGFR showed a significant correlation with AHI（r=-0.154, P=0.008）, ODI（r=-0.236,P〈0.01）,and LSaO2（r=0.145, P=0.024）.Logistic regression revealed that eGFR（OR=0.991, 95%CI 0.983~0.998, P=0.014）, BMI（OR=1.107, 95%CI 1.028~1.193, P=0.008）were independent risk factors for AHI.There were significant differences in age, urinary albumin, AHI, ODI, LSaO2 among groups with various eGFR levels （P〈0.05）.Stepwise regression showed that age（β=-0.456, 95%CI-0.571^-0.346,P〈0.01）and AHI（β=-0.119, 95%CI-0.226^-0.007,P=0.037） were independent risk factors for eGFR.Conclusions OSAHS is a risk factor for renal impairment in patients with T2DM.

关 键 词：阻塞性睡眠呼吸暂停低通气综合征 糖尿病  2型 慢性肾脏病变 

分 类 号：R587.2[医药卫生—内分泌] R766[医药卫生—内科学]