阻塞性睡眠呼吸暂停低通气综合征对老年人2型糖尿病视网膜病变进程的影响  

Effects of obstructive sleep apnoea-hypoapnoea syndrome on retinopathy processes in elderly patients with type 2 diabetes mellitus

作　　者：谢香荣[1] 李会琳[1] 王青[1] 陶天畅 郝少峰[1] Xie Xiangrong;Li Huilin;Wang Qing;Tao Tianchang;Hao Shaofeng(Department of Ophthalmology,Heji Hospital Affiliated to Shanxi Changzhi Medical College,Changzhi 046011;Department of Ophthalmology,Beijing Tongren Hospital,Capital Medical University,Beijing Ophthalmology and Visual Science Key Lab,Beijing 100730,China)

机构地区：[1]山西省长治医学院附属和济医院眼科,长治046011 [2]首都医科大学附属北京同仁医院眼科中心北京市眼科学与视觉科学重点实验室,北京100020

出　　处：《中华老年医学杂志》2019年第10期1126-1130,共5页Chinese Journal of Geriatrics

摘　　要：目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)对老年2型糖尿病视网膜病变(DR)进程的影响,并分析影响DR的危险因素。方法回顾性研究,选择我院自2012年1月至2014年12月收治的老年2型糖尿病无DR的患者,按照是否合并OSAHS分为OSAHS组42例和对照组85例。随访36个月,比较两组患者DR进展情况,并分析不同严重程度的OSAHS对DR的影响,多因素Logistic回归分析影响DR的危险因素。结果OSAHS组患者的收缩压、舒张压和Epworth嗜睡量表评分均高于对照组患者(均P<0.05)。平均随访(34.5±6.7)个月,两组患者的体质指数、肾功能和心功能均降低(均P<0.05),且OSAHS组的收缩压、舒张压、餐后2 h血糖和Epworth嗜睡量表评分仍高于对照组患者(均为P<0.05),肾小球滤过率和左心室射血分数均低于对照组患者(均为P<0.05)。OSA组的轻度和中重度非增生型DR发生率均高于对照组(均为P<0.05)。亚组分析结果显示,中重度OSAHS组的DR发生率高于对照组患者(OR=4.57,95%CI:1.24~13.78,P=0.002),而轻度OSAHS组患者DR发生率与对照组患者相似(OR=2.33,95%CI:0.66~12.56,P=0.29)。多因素Logistic回归分析显示,糖尿病病程≥7年(OR=3.24,95%CI:1.80~9.59)、随访时糖化血红蛋白(HbA1c)≥7.5%(OR=2.07,95%CI:1.41~8.52)、随访时肾小球滤过率(GFR)<60 ml/min(OR=4.52,95%CI:1.75~14.26)和呼吸暂停低通气指数(AHI)≥15次/h(OR=2.03,95%CI:1.37~11.24)是影响DR的独立危险因素(均为P<0.05)。结论OSAHS患者易合并高血压、血糖升高,更易出现心、肾功能不全和DR。糖尿病病程≥7年、随访时HbA1c≥7.5%、随访时GFR<60 ml/min和AHI≥15次/h是影响DR的独立危险因素,但需更多研究结果证实。Objective To investigate the effect of obstructive sleep apnoea-hypoapnoea syndrome(OSAHS)on diabetic retinopathy(DR)in elderly patients with type 2 diabetes mellitus(T2DM)and analyze risk factors for DR process.Methods Data of elderly diabetic patients without DR admitted into our hospital from January 2012 to December 2014 were retrospectively analyzed.Based on whether or not to combine OSAHS,patients were divided into the OSAHS group(n=42)and the control group(n=85).After 36 months'follow-up,the incidence and progression of DR were compared,and the effect of different degree of OSAHS on DR was analyzed.Multivariate logistic regression analysis was used to analyze the risk factors for DR.Results The systolic pressure,diastolic pressure and Epworth sleepiness scores were higher in the OSAHS group than in the control group(P<0.05).At the(34.5±6.7)months of follow-up versus baseline,body mass index,renal function and cardiac function were markedly decreased in both groups(P<0.05).The systolic pressure,diastolic pressure,2-h postprandial blood glucose and Epworth sleepiness scores were higher in the OSAHS group than in the control group;and the glomerular filtration rate(GFR)and left ventricular ejection fraction were lower in the OSAHS group than in the control group(P<0.05).The incidences of mild,moderate and severe non-proliferative DR were higher in the OSAHS group than in the control group(P<0.05).The results of subgroup analysis showed that the incidence of DR was higher in patients with moderate to severe OSAHS than in controls(OR=4.57,95%CI:1.24~13.78,P=0.002),while the incidence of DR in patients with mild OSAHS was similar to that in the controls(OR=2.33,95%CI:0.66~12.56,P=0.29).Multivariate logistic regression analysis showed that T2DM duration≥7 years(OR=3.24,95%CI:1.80-9.59,P<0.05),haemoglobin A1c(HbA1c)≥7.5%(OR=2.07,95%CI:1.41-8.52,P<0.05),GFR<60 ml/min(OR=4.52,95%CI:1.75-14.26,P<0.05)and apnea/hyponea index≥15/h(OR=2.03,95%CI:1.37-11.24,P<0.05)were independent risk factors for DR.Conclusions O

关 键 词：糖尿病视网膜病变 睡眠呼吸暂停 阻塞性 

分 类 号：R76[医药卫生—耳鼻咽喉科]