摘要
目的:研究阻塞性睡眠呼吸暂停综合征(OSAS)造成的肾脏早期损害。方法:选择OSAS患者180例,健康对照组60例均行多导睡眠监测仪(PSG)检查,根据呼吸暂停低通气指数(AHI)和夜间最低脉搏血氧饱和度(LSpO_2)的变化分为轻、中、重度三组,检测血清尿素氮(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)、尿肾损伤分子(uKIM-1)的水平,比较各组之间的差异。另外从中、重度组中各随机抽取30例患者进行持续正压通气(CPAP)治疗,1个月后复查相关指标并比较治疗前、后的变化。结果:OSAS各亚组的BUN、SCr、肾小球滤过率(GFR)水平较健康对照组无明显差异但重度OSAS组的sCys C水平较健康对照组、轻度组及中度组存在统计学差异。OSAS各亚组的UACR、uβ_2-MG、uCys C及uKIM-1水平均较对照组明显升高,各组间的uCys C及uKIM-1水平亦存在统计学差异。重度组UACR、uβ_2-MG水平明显高于轻、中度组但轻、中度组之间UACR、uβ_2-MG水平无统计学差异。OSAS患者AHI与uCys C及uKIMq水平存在显著相关性。中、重度OSAS患者CPAP治疗前后AHI、LSpO_2、sCys C、UACR、uβ_2-MG、uCys C及uKIM-1水平存在统计学差异,BUN、SCr、GFR水平无统计学差异。结论:OSAS患者早期肾功能损伤以肾小管损伤为主,UACR、uβ_2-MG、uCys C、uKIM-1及sCys C的变化早于BUN、SCr、GFR水平的变化,其中以uCys C及uKIM-1最为敏感,可作为评估OSAS早期肾脏损害的标志物。CPAP治疗可明显改善OSAS肾脏损害。
Objective:To study the early renal damage caused by obstructive sleep apnea syndrome(OSAS).Methodology:One hundred eighty- OSAS patients and were evaluated by polysonmography during sleep,and 60 healthy individuals were regarded as controls.The levels of serum creatinine(SCr),serum cystatin C(sCys C) and other biochenfical data were measured.The levels of urine ACR、β_2-MG、Cys C and KIM-1 were also detected.30 cases sampled randomly from moderate and severe degree OSAS patients respectively were treated by continuous positive airway- pressure(CPAP).The correlation data was detected one month later to known whether there was a change before and after treatment.Results:There was no difference in the level of BUN,SCr and GFR between OSAS group and control group.The level of sCys C in severe degree group was higher than that in control group,mild and moderate degree group.The level of UACR、uβ_2-MG、uCys C and uKIM-1 in OSAS group was significantly higher than that in control group,and there was significant difference in each OSAS subgroups.The level of UACR、uβ_2-MG in severe degree OSAS group was higher than that in mild and moderate degree group.The level of apnea hypopnea index(AHI) in OSAS group was positive correlated to uCys C and uKIM-1.The level of AHI,the lowest pulse oxygen saturation(LSpO_2) at night、sCys C、UACR、uβ_2-MG、uCys C and uKIM-1 were significantly reduced by CPAP treatment.Conclusion:The early kidney injury- caused by OSAS is a main of renal tubular injury.The levels of UACR、uβ_2-VIG、uCys C、uKIM-1 and sCys C are significantly increased in patients with kidney injury,and their changes are earlier than those of conventional renal functions.They may be used as sensitive indicators for monitoring early renal damage in patients with OSAS.Early kidney injury of OSAS can be reversed by CPAP treatment.
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
北大核心
2016年第1期20-24,共5页
Chinese Journal of Nephrology,Dialysis & Transplantation
基金
十二五国家科技支撑计划课题(2011BAI10B08)
关键词
睡眠呼吸暂停综合征
肾脏损害
肺通气
obstructive sleep apnea syndrome
early renal damage
lung ventilation