阻塞性睡眠呼吸暂停低通气综合征与2型糖尿病肾病发生和进展的相关性研究  

Relationship between obstructive sleep apnea hypopnea syndrome and the occurrence and progression of type 2 diabetic nephropathy

作　　者：钱科威[1] 顾晓琦 曹蓓[1] 袁婕 孙晓红[1] 章敏 Qian Ke-wei;Gu Xiao-qi;Cao Bei;Yuan Jie;Sun Xiao-hong;Zhang Min(Department of Endocrinology,Zhangjiagang Traditional Chinese Medicine Hospital(Zhangjiagang Hospital,Nanjing University of Traditional Chinese Medicine),Zhangjiagang 215600,China;Department of Endocrinology&Metabolism,Chang zhou First People’s Hospital,Changzhou 213003,China)

机构地区：[1]张家港市中医医院(南京中医药大学附属张家港医院)内分泌科,215600 [2]常州市第一人民医院内分泌代谢科,213003

出　　处：《临床肾脏病杂志》2021年第7期546-550,共5页Journal Of Clinical Nephrology

基　　金：江苏省卫生计生委2017年医学科研课题面上课题(H201702)。

摘　　要：目的研究2型糖尿病(type 2 diabetes,T2DM)患者中阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)与糖尿病肾病(diabetic nephropathy,DN)发生和进展的相关性。方法选取2019年6月1日至2020年5月30日期间在张家港市中医医院住院的DN患者92例,同时选取同时期未合并DN的T2DM患者75例。所有入组患者均在常规诊疗的基础上,检测血清胱抑素、γ-氨基丁酸(γ-aminobutyric acid,γ-GABA)、尿白蛋白排泄量(urine albumin excretion,UAE)。行多导睡眠检测仪连续记录8 h,记录呼吸暂停-低通气指数(apnea-hypopnea index,AHI)、夜间最低血氧饱和度(lowest arterial oxygen saturation,LSaO 2)和夜间平均血氧饱和度(mean arterial oxygen saturation,MSaO 2)。结果两组患者年龄、性别构成、体重指数(body mass index,BMI)、空腹血糖、合并高血压及高胆固醇血症的差异均无统计学意义。DN患者平均糖尿病病程延长,OSAHS发生率增加,糖化血红蛋白(hemoglobin a1c,HbA1c)、血清胱抑素C(cystatinC,CysC)、AHI的水平升高,LSaO 2、MSaO 2及γ-GABA的水平降低(P<0.05)。按UAE水平将DN患者分为正常白蛋白尿组、微量白蛋白尿组和大量白蛋白尿组,比较3组OSAHS缺氧相关性指标,发现随着DN的进展,AHI发生次数明显增加,而LSaO 2、MSaO 2及γ-GABA的水平显著降低(P<0.05)。进一步行多元Logistic回归分析结果发现,AHI是T2DM患者DN发病的独立危险因素(P=0.044),而LSaO 2、MSaO 2、γ-GABA是DN发病的独立保护因素(P<0.01)。结论OSAHS缺氧严重程度与DN的进展相关,改善OSAHS可能有助于减慢DN的进展。Objective To explore the correlation between obstructive sleep apnea hypopnea syndrome(OSAHS)and diabetic nephropathy(DN)in type 2 diabetes mellitus(T2DM)patients.Methods A total of 92 T2DM patients with DN during June 1-May 30,2020 were selected while 75 T2DM patients without DN during the same period designated as controls.All patients were tested for serum cystatin C,γ-aminobutyric acid(γ-GABA)and urine albumin excretion(UAE)on the basis of routine diagnosis and treatment.Polysomnograph was utilized for 8-hour continuous recording and apnea-hypopnea index(AHI),minimum night blood oxygen saturation(LSaO 2)and night average blood oxygen saturation(MSaO 2)were recorded.Results No inter-group statistical differences existed in age,gender composition,body mass index(BMI),fasting blood glucose,hypertension or hypercholesterolemia.The average diabetic duration was prolonged in DN patients,the incidence of OSAHS spiked.The levels of HbA1c,CysC and AHI rose while the levels of LSaO 2,MSaO 2 andγ-GABA declined(all P<0.05).They were divided into three groups of normal albuminuria,micro-albuminuria and massive albuminuria according to the level of UAE.The disease courses of DN and AHI became elongated markedly while LSaO 2,MSaO 2 andγ-GABA declined markedly(all P<0.05).Further multivariate Logistic regression analysis indicated that AHI was an independent risk factor for an onset of DN(P=0.044)while LSaO 2,MSaO 2 andγ-GABA were independent protective factors for DN in T2DM patients(all P<0.01).Conclusion OSAHS is correlated with DN occurrence so that alleviating OSAHS may delay the progression of DN.

关 键 词：睡眠呼吸暂停 阻塞性 糖尿病 2型 糖尿病肾病 Γ氨基丁酸 

分 类 号：R766[医药卫生—耳鼻咽喉科] R587.2[医药卫生—临床医学] R692.9