阻塞性睡眠呼吸暂停的肾功能损伤及危险因素的研究  

Study on the Risk Factors for Renal Impairment in Obstructive Sleep Apnea

作　　者：宋诗文 郭世放 秦兵俊 蒋军广[1] SONG Shiwen;GUO Shifang;QIN Bingjun;JIANG Junguang(Elderly Respiratory Sleep Department,The First Affiliated Hospital of Zhengzhou University,Henan Institute of Respiratory Disease,Zhengzhou,Henan 450052,P.R.China)

机构地区：[1]郑州大学第一附属医院河南省呼吸疾病研究所老年呼吸睡眠科,河南郑州450052

出　　处：《中国呼吸与危重监护杂志》2024年第12期850-855,共6页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的研究阻塞性睡眠呼吸暂停(Obstructive Sleep Apnea,OSA)患者肾功能损伤以及引起肾功能损伤的危险因素。方法收集2022年7月—2023年1月期间,在我科行多导睡眠监测(polysomnography,PSG)患者的数据,共计178例,根据多导睡眠监测结果,将患者分为OSA组(145例)及非OSA组(33例)。根据病情严重程度将OSA组进一步分为轻度OSA组(21例)、中度OSA组(28例)、重度OSA组(96例),进一步分析了其血清尿素氮(Blood Urea Nitrogen,BUN)、血清胱抑素C(Cystatin C,Cys-C)浓度和肾小球滤过率(estimated Glomerular filtration rate,eGFR)与可能影响肾功能损伤的各危险因素之间的Pearson相关性分析,并采用多重线性回归分析影响BUN、Cys-C和eGFR的危险因素。结果两组间进行比较时的年龄、体重、体质指数(BMI)、颈围、腰围、eGFR、Cys-C、BUN、最低血氧饱和度(LSaO2)、睡眠期间血氧饱和度低于90%的时间比例(CT90%)等检测指标均有统计学意义(P均<0.05)。采用单因素方差分析轻、中及重度OSA患者的BUN、血清肌酐(Serum creatinine,SCr)、Cys-C以及eGFR之间的差异,结果表明,eGFR和Cys-C在不同严重程度的OSA患者中有统计学意义。进一步运用Pearson相关性检验分析eGFR、BUN和Cys-C与可能影响肾功能的危险因素之间的关联,然后以上述三个指标为因变量,建立多重线性回归,评估可能影响肾功能损伤的危险因素。结果显示,eGFR与年龄、身体质量指数(Body Mass IndexC,BMI)、CT90%呈负相关(β=-0.95,P=0.00;β=-1.36,P=0.01;β=-32.64,P=0.00);BUN与CT90%呈正相关(β=0.22,P=0.01);Cys-C与CT90%呈正相关(β=0.58,P=0.00);结论OSA患者肾功能损伤发生率较高,慢性间歇性缺氧、年龄、肥胖是引起肾功能损伤的危险因素。Objective To investigate the renal impairment and the risk factors of renal impairment in patients with OSA.Methods Data from patients who underwent polysomnography(PSG)in our department from July 2022 to January 2023 were collected,totaling 178 cases.Based on the results of the polysomnography,the patients were divided into an OSA group(145 cases)and a non-OSA group(33 cases).According to the severity of the condition,the OSA group was further divided into mild OSA(21 cases),moderate OSA(28 cases),and severe OSA(96 cases).The Pearson correlation analysis was further conducted to analyze the relationships between serum urea nitrogen(BUN),serum cystatin C(Cys-C)concentrations,and estimated Glomerular Filtration Rate(eGFR)with various risk factors that may influence renal impairment.Moreover,multiple linear regression analysis was used to identify the risk factors affecting BUN,Cys-C,and eGFR.Results When comparing the two groups,there were statistically significant differences in age,weight,BMI,neck circumference,waist circumference,eGFR、Cys-C、BUN,LSaO2,CT90%(all P<0.05).Univariate analysis of variance was used to compare differences in BUN,Serum creatinine(SCr),Cys-C,and eGFR among patients with mild,moderate,and severe OSA,indicating that differences in eGFR and Cys-C among OSA patients of varying severities were statistically significant.Further analysis with Pearson correlation was conducted to explore the associations between eGFR,BUN,and Cys-C with potential risk factors that may affect renal function.Subsequently,multiple linear regression was utilized,taking these three indices as dependent variables to evaluate risk factors potentially influencing renal dysfunction.The results demonstrated that eGFR was negatively correlated with age,BMI,and CT90%(β=−0.95,P<0.001;β=−1.36,P=0.01;β=−32.64,P<0.001);BUN was positively correlated with CT90%(β=0.22,P=0.01);Cys-C was positively correlated with CT90%(β=0.58,P<0.001).Conclusion Chronic intermittent hypoxia,age,and obesity are risk factors for renal

关 键 词：阻塞性睡眠呼吸暂停 慢性肾脏病 慢性间歇性缺氧 

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