【摘要】：目的:研究阻塞性睡眠呼吸暫停綜合征(OSAS)造成的腎臟早期損害。方法:選擇OSAS患者180例,健康對照組60例均行多導(dǎo)睡眠監(jiān)測儀(PSG)檢查,根據(jù)呼吸暫停低通氣指數(shù)(AHI)和夜間最低脈搏血氧飽和度(LSpO_2)的變化分為輕、中、重度三組,檢測血清尿素氮(BUN)、血清肌酐(SCr)、血清胱抑素C(sCys C)、尿微量白蛋白/尿肌酐(UACR)、尿β_2微球蛋白(uβ_2-MG)、尿胱抑素C(uCys C)、尿腎損傷分子(uKIM-1)的水平,比較各組之間的差異。另外從中、重度組中各隨機(jī)抽取30例患者進(jìn)行持續(xù)正壓通氣(CPAP)治療,1個月后復(fù)查相關(guān)指標(biāo)并比較治療前、后的變化。結(jié)果:OSAS各亞組的BUN、SCr、腎小球濾過率(GFR)水平較健康對照組無明顯差異但重度OSAS組的sCys C水平較健康對照組、輕度組及中度組存在統(tǒng)計學(xué)差異。OSAS各亞組的UACR、uβ_2-MG、uCys C及uKIM-1水平均較對照組明顯升高,各組間的uCys C及uKIM-1水平亦存在統(tǒng)計學(xué)差異。重度組UACR、uβ_2-MG水平明顯高于輕、中度組但輕、中度組之間UACR、uβ_2-MG水平無統(tǒng)計學(xué)差異。OSAS患者AHI與uCys C及uKIMq水平存在顯著相關(guān)性。中、重度OSAS患者CPAP治療前后AHI、LSpO_2、sCys C、UACR、uβ_2-MG、uCys C及uKIM-1水平存在統(tǒng)計學(xué)差異,BUN、SCr、GFR水平無統(tǒng)計學(xué)差異。結(jié)論:OSAS患者早期腎功能損傷以腎小管損傷為主,UACR、uβ_2-MG、uCys C、uKIM-1及sCys C的變化早于BUN、SCr、GFR水平的變化,其中以uCys C及uKIM-1最為敏感,可作為評估OSAS早期腎臟損害的標(biāo)志物。CPAP治療可明顯改善OSAS腎臟損害。
[Abstract]:Objective: to study the early renal damage caused by obstructive sleep apnea syndrome (OSAS). Methods: 180 patients with OSAS and 60 healthy controls were examined by polysomnography (PSG). According to the changes of apnea hypopnea index (AHI) and nocturnal minimum pulse oxygen saturation (LSpO_2), they were divided into three groups: mild, moderate and severe. The levels of urinary 尾 _ 2 microglobulin (u 尾 _ 2-MG), urinary cystatin C (uCys C), (C (uCys C),) and urinary renal injury molecule (uKIM-1) in serum urea nitrogen (BUN),) and serum creatinine (SCr),) were determined. In addition, 30 patients in the severe group were randomly selected for continuous positive pressure ventilation (CPAP) therapy. After one month, the related indexes were reviewed and the changes before and after treatment were compared. Results: there was no significant difference in BUN,SCr, glomerular filtration rate (BUN,SCr,) (GFR) level in each subgroup of OSAS compared with the healthy control group, but the sCys C level in the severe OSAS group was higher than that in the healthy control group. The levels of UACR,u 尾 _ 2-MGG uCys C and uKIM-1 in each subgroup of OSAS were significantly higher than those in the control group, and the levels of uCys C and uKIM-1 in each group were also significantly higher than those in the control group. The level of UACR,u 尾 _ 2-MG in severe group was significantly higher than that in mild group, moderate group but mild group, moderate group. There was no significant difference in UACR,u 尾 _ 2-MG level between severe group and moderate group. There was a significant correlation between AHI and uCys C and uKIMq levels in OSAS patients. In moderate and severe OSAS patients, there were significant differences in AHI,LSpO_2,sCys 尾 _ 2-MGG UCys C and uKIM-1 levels before and after CPAP treatment, but no significant difference was found in BUN,SCr,GFR level. Conclusion: renal tubular injury is the main type of renal function injury in the early stage of OSAS patients. The changes of UACR,u 尾 _ 2-MGUCys CnuKIM-1 and sCys C are earlier than that of BUN,SCr,GFR, and uCys C and uKIM-1 are the most sensitive. It can be used as a marker to evaluate early renal damage in OSAS. CPAP therapy can significantly improve renal damage of OSAS.
【作者單位】： 大連醫(yī)科大學(xué)附屬第二醫(yī)院呼吸科;大連醫(yī)科大學(xué)附屬第二醫(yī)院腎內(nèi)科;
【基金】：十二五國家科技支撐計劃課題(2011BAI10B08)
【分類號】：R766
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本文編號：2291856