本文選題：阻塞性睡眠呼吸暫停低通氣綜合征 + 慢性腎功能不全��； 參考：《鄭州大學》2017年碩士論文

【摘要】：背景與目的阻塞性睡眠呼吸暫停低通氣綜合征(OSAHS)是一種常見的呼吸系統(tǒng)疾病,其特點為反復出現(xiàn)的上氣道塌陷,導致的低氧血癥及睡眠呼吸暫停,并可造成全身多系統(tǒng)損害(包括腎功能損害)。國外多個描述性研究已經(jīng)證實,OSAHS與慢性腎臟病之間存在關(guān)聯(lián),OSAHS會引起患者的腎功能損害,國外學者在一項研究中發(fā)現(xiàn),OSAHS患者中CKD的患病率高達30.5%,且與睡眠呼吸暫停和夜間低氧血癥有關(guān)。本研究以血清尿素氮、血清肌酐、血清胱抑素C濃度及e GFR為指標,探討OSAHS患者是否存在腎功能損害及引起腎功能損害的危險因素,為臨床OSAHS患者發(fā)展為CKD的防治提供依據(jù)。對象與方法收集2016年7月至2017年1月期間,在鄭州大學第一附屬醫(yī)院老年呼吸睡眠科睡眠診療中心行多導睡眠監(jiān)測(PSG)的患者175例,最終確診為OSAHS的患者145例(OSAHS組)及健康患者33例(非OSAHS組),排除患有糖尿病、高血壓、高脂血癥及有急性腎功能不全、腎小球疾病、泌尿系感染等疾病的患者。經(jīng)問卷調(diào)查、體格檢查及至少7小時的PSG監(jiān)測,監(jiān)測并詳細記錄患者的性別、年齡、身高、體重、頸圍、腰圍、體重指數(shù)(BMI)、AHI、最低Sa O_2(La SO_2)、SaO_2低于90%時間占總睡眠時間百分比(CT90%)、血清胱抑素C、血清肌酐、血清尿素氮、腎小球濾過率、空腹血糖、膽固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白及血壓等指標,應(yīng)用SPSS 22.0軟件,根據(jù)研究變量不同,采用t檢驗、卡方檢驗、秩和檢驗分別對OSAHS組和非OSAHS組進行分析,然后對OSAHS組患者的血清尿素氮、血清胱抑素C濃度及腎小球濾過率(e GFR)與影響腎功能損害的各危險因素進行Pearson相關(guān)分析,并以血清尿素氮、血清胱抑素C濃度及腎小球濾過率(e GFR)為結(jié)局變量進行多重線性回歸分析(P0.05)。結(jié)果1 145例OSAHS患者中發(fā)生腎功能損害的患者占21.8%,其中6.9%的患者為中重度腎功能損害。2兩組間比較發(fā)現(xiàn),e GFR:OSAHS組(?)±s為(103.490±27.260)ml/min·1.73m~2,非OSAHS組為(115.355±27.630)ml/min·1.73m~2,差異有統(tǒng)計學意義(t=-2.251,P=0.026);Cys C:OSAHS組(?)±s為(0.979±0.377)mg/L,非OSAHS組(0.830±0.115)mg/L,差異有統(tǒng)計學意義(t=2.239,P=0.026);BUN:OSAHS組(?)±s為(5.519±1.859)mmol/L,非OSAHS組(4.750±0.896)mmol/L,差異有統(tǒng)計學意義(t=2.312,P=0.022);年齡:OSAHS組(?)±s為(50.060±11.112)歲,非OSAHS組(43.090±12.546)歲,差異有統(tǒng)計學意義(t=3.171,P=0.002);體重:OSAHS組(?)±s為(83.266±13.460)Kg,非OSAHS組為(72.091±9.221)Kg,差異有統(tǒng)計學意義(t=4.529,P=0.000);BMI:OSAHS組(?)±s為(28.894±4.010)Kg/m~2,非OSAHS組(?)±s為(25.401±3.103)Kg/m~2,差異有統(tǒng)計學意義(t=4.690,P=0.000);頸圍:OSAHS組(?)±s為(41.430±2.728)cm,非OSAHS組(?)±s為(38.970±2.756)cm,差異有統(tǒng)計學意義(t=4.663,P=0.000);腰圍:OSAHS組(?)±s為(102.940±9.129)cm,非OSAHS組(?)±s為(95.210±8.517)cm,差異有統(tǒng)計學意義(t=4.44,P=0.000);LSa O_2:OSAHS組(?)±s為(73.840±11.178)%,非OSAHS組(?)±s為(89.880±4.136)%,差異有統(tǒng)計學意義(t=-8.102,P=0.000);CT90%:OSAHS組(?)±s為(16.950±19.693)%,非OSAHS組(?)±s為(0.250±0.675)%,差異有統(tǒng)計學意義(t=4.861,P=0.000);最長呼吸暫停時間:OSAHS組(?)±s為(62.041±27.491)s,非OSAHS組為(26.279±16.904)s,差異有統(tǒng)計學意義(t=7.162,P=0.000)。而性別、身高、血清肌酐、血糖、SBP、DBP、T-CHO、TG、HDL及LDL在兩組間差異均無統(tǒng)計學意義(P均0.005)。3采用單因素方差分析BUN、SCr、Cys C、e GFR在輕、中、重度OSAHS患者中的組間差異發(fā)現(xiàn),e GFR:輕度OSAHS組±s為(111.605±20.893)ml/min·1.73m~2,中度OSAHS組為(82.947±28.443)ml/min·1.73m~2,重度OSAHS組為(82.947±28.443)ml/min·1.73m~2,差異有統(tǒng)計學意義(P=0.028);Cys C:輕度OSAHS組±s為(0.824±0.118)mg/L,中度OSAHS組(1.008±0.255)mg/L,重度OSAHS組(1.043±0.441)mg/L,差異有統(tǒng)計學意義(P=0.041);BUN、SCr在三組間比較差異均無統(tǒng)計學意義(P均0.05)。4在OSAHS組中,應(yīng)用Preason相關(guān)性檢驗分別分析e GFR、BUN、Cys C與影響腎功能損害的各危險因素的相關(guān)性,研究發(fā)現(xiàn)e GFR與年齡、BMI、CT90%呈負相關(guān)(r=-0.343,P=0.000;r=-0.207,P=0.012;r=-0.300,P=0.000);BUN與體重、頸圍、CT90%呈正相關(guān)(r=0.166,P=0.045;r=0.194,P=0.019;r=0.255,P=0.002);Cys C與體重、BMI、頸圍、腰圍、AHI、CT90%、最長呼吸暫停時間呈正相關(guān)(r=0.353,P=0.000;r=0.333,P=0.000;r=0.193,P=0.020;r=0.206,P=0.013;r=0.366,P=0.000;r=0.582,P=0.000;r=0.202,P=0.015),與LSa O_2呈負相關(guān)(r=-0.296,P=0.000)。再分別以e GFR、BUN、Cys C為因變量,與腎功能損害相關(guān)的危險因素為自變量,采用多重線性回歸分析各因素對e GFR、BUN、Cys C的影響,結(jié)果示:e GFR與年齡、BMI、CT90%相關(guān)(β=-0.947,P=0.000;β=-1.361,P=0.011;β=-32.639,P=0.001);Cys C與CT90%相關(guān)(β=0.576,P=0.000);BUN與CT90%相關(guān)(β=0.223,P=0.010)。結(jié)論1 OSAHS患者存在腎功能損害,且腎功能損害程度隨著OSAHS程度的加重而加重。2血氧飽和度低于90%時間占總睡眠時間百分比是引起OSAHS患者腎功能損害的獨立危險因素。3 e GFR、胱抑素C可以作為OSAHS患者早期腎功能損害的檢測指標。
[Abstract]:BACKGROUND & OBJECTIVE To study the risk factors of renal function damage and renal function damage in patients with obstructive sleep apnea . There was significant difference in serum urea nitrogen , serum cystatin C concentration and glomerular filtration rate ( e GFR ) . The results showed that the serum urea nitrogen , serum cystatin C concentration and glomerular filtration rate ( e GFR ) were ( 3.490 鹵 27.260 ) ml / min 路 1.73m ~ 2 , and the difference was statistically significant ( t = 2.239 , P = 0.000 ) . The difference was statistically significant ( t = 4.64 , P = 0.000 ) , and the difference was statistically significant ( t = 4.64 , P = 0.000 ) , while the difference was statistically significant ( t = 4.861 , P = 0.000 ) . There was no significant difference between the two groups ( P = 0.041 ) , the difference was ( 82.947 鹵 28.443 ) ml / min 路 1.73m ~ 2 , and the difference was statistically significant ( P = 0.041 ) . There was a positive correlation between the levels of serum BUN and SCr ( r = - 0.207 , P = 0.012 ; r = - 0.300 , P = 0.000 ) ; BUN and body weight , neck circumference , CT90 % were positively correlated ( r = 0.166 , P = 0.045 ) . r = 0.194 , P = 0.019 ; r = 0.255 , P = 0.002 ) ; Cys C was positively correlated with body weight , BMI , neck circumference , waist circumference , ahi , CT90 % , longest apnea time ( r = 0.333 , P = 0.000 ; r = 0.582 , P = 0.000 ; r = 0.202 , P = 0.015 ) , negatively correlated with LSa O _ 2 ( r = - 0.296 , P = 0.000 ) . The effects of various factors on e GFR , BUN and Cys C were analyzed by multiple linear regression . The results showed that e GFR was correlated with age , BMI , CT90 % ( 尾 = - 0.947 , P = 0.000 ; 尾 = - 1.361 , P = 0 . 011 ; 尾 = - 32.639 , P = 0.001 ) ; Cys C was correlated with CT90 % ( 尾 = 0.576 , P = 0.000 ) ; BUN was correlated with CT90 % ( 尾 = 0.223 , P = 0.010 ) . Conclusion The degree of renal function damage in patients with obstructive sleep apnea is more than 90 % . The percentage of total sleep time is the independent risk factor which causes the renal function damage in patients with obstructive sleep apnea syndrome .

【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R766;R692

【參考文獻】

相關(guān)期刊論文 前4條

1 李彥如;丁秀;邊秋麗;葉京英;;體重變化對阻塞性睡眠呼吸暫停低通氣綜合征的影響[J];中國耳鼻咽喉頭頸外科;2014年01期

2 董佳佳;葉京英;張俊波;曹鑫;檀俊龍;;懸雍垂腭咽成形術(shù)聯(lián)合軟腭前移術(shù)后氣道結(jié)構(gòu)變化的研究[J];中華耳鼻咽喉頭頸外科雜志;2013年04期

3 雷志堅;劉建紅;劉航;梁碧芳;;體位干預對輕中度阻塞性睡眠呼吸暫停低通氣綜合征患者的效果觀察[J];廣西醫(yī)學;2012年07期

4 ;中國成人血脂異常防治指南[J];中華心血管病雜志;2007年05期

，

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