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浙江大学学报（医学版）
浙江大学学报（医学版）  2016, Vol. 45 Issue (3): 261-267    DOI: 10.3785/j.issn.1008-9292.2016.05.07
原著     
高血压伴阻塞性睡眠呼吸暂停低通气综合征患者肾功能影响因素分析
蒋倩倩1,2, 珠勒皮亚·司马义1, 陈玉岚1, 周晓欢1, 张向阳1, 徐新娟1, 叶红3
1. 新疆医科大学第一附属医院高血压科, 新疆维吾尔自治区 乌鲁木齐 830054;
2. 新疆医科大学第一附属医院感染科, 新疆维吾尔自治区 乌鲁木齐 830054;
3. 新疆医科大学第一附属医院呼吸二科, 新疆维吾尔自治区 乌鲁木齐 830054
Influencing factors of renal function in hypertensive patients with obstructive sleep apnea-hypopnea syndrome
JIANG Qianqian1,2, ZHULEPIYA Simayi1, CHEN Yulan1, ZHOU Xiaohuan1, ZHANG Xiangyang1, XU Xinjuan1, YE Hong3
1. Department of Hypertension, the First Teaching Hospital of Xinjiang Medical University, Urumqi 830054, China;
2. Department of Infectious Diseases, the First Teaching Hospital of Xinjiang Medical University, Urumqi 830054, China;
3. Department of Respiratory Medicine, the First Teaching Hospital of Xinjiang Medical University, Urumqi 830054, China
全文: PDF(1005 KB)  
摘要: 

目的：分析伴阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的高血压患者肾功能的影响因素。方法：选取2011年3月至2014年3月在新疆医科大学第一附属医院确诊的高血压患者，对诉有夜间打鼾的438例患者行多导睡眠呼吸监测，根据呼吸暂停低通气指数（AHI）分为单纯高血压组（AHI<10次/h，102例）、轻度OSAHS组（AHI 10～<15次/h，97例）、中度OSAHS组（AHI 15～<30次/h，149例）、重度OSAHS组（AHI≥30次/h，90例），检测四组血尿素、肌酐、估算肾小球滤过率、24 h尿蛋白、24 h尿微量白蛋白、血清胱抑素C水平，分析其相关因素。结果：单纯高血压组和高血压伴不同程度OSAHS组患者年龄、性别构成比、体质指数、24 h平均收缩压、空腹血糖、高密度脂蛋白胆固醇（HDL-C）等基线资料差异有统计学意义（均P<0.05）；重度OSAHS组24 h尿蛋白和24 h尿微量白蛋白高于其他各组；不同程度OSAHS组血清胱抑素C高于单纯高血压组（均P<0.05）；多因素logistic回归分析结果显示：体质指数（OR=1.486，95%CI：1.022～2.160）、重度OSAHS（OR=7.138，95%CI：1.835～27.769）为24 h尿蛋白的影响因素；血压控制情况（OR=2.368，95%CI：1.324～4.234）、体质指数（OR=1.678，95%CI：1.263～2.230）为24 h尿微量白蛋白的影响因素；年龄（OR=1.998，95%CI：1.325～3.013）、血压控制情况（OR=3.202，95%CI：1.319～7.773）、重度OSAHS（OR=5.462，95%CI：1.103～27.041）为血清胱抑素C的影响因素。结论：年龄、体质指数、血压控制情况、体质指数、重度OSAHS为高血压伴OSAHS患者肾功能损害的影响因素。OSAHS是高血压患者肾脏早期损害的危险因素。
关键词 ： 睡眠呼吸暂停,阻塞性/诊断,  睡眠呼吸暂停,阻塞性/并发症,  高血压/病因学,  蛋白尿/尿,  白蛋白尿/尿,  肾/病理生理学,  回顾性研究    
Abstract：

Objective: To investigate the related factors of renal functions in hypertensive patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods: A total of 438 hypertensive patients with complain of snoring at night were enrolled in the study from the First teaching Hospital of Xinjiang Medical University during March 2011 and March 2014. The diagnosis of OSAHS was confirmed with polysomnography examination, and the patients were divided into 4 groups according to the apnea hypoventilation index (AHI): hypertensive group (AHI<10/h, n=102), mild OSAHS group (AHI 10-<15/h, n=97), moderate OSAHS group (AHI 15-<30/h, n=149), and severe OSAHS group (AHI≥30/h, n=90). The blood urea, creatinine, eGFR, 24h-urinary total protein (24h UTP), 24h-urinary microalbumin, cystatin C (Cyst C) were measured and compared among groups, and the influencing factors of renal function were analyzed. Results: There were no significant differences in age, gender, body mass index(BMI), 24-hour systolic blood pressure (24hSBP), fasting blood-glucose, high-density lipoprotein cholesterol (HDL-C) among the groups (P<0.05). 24h-UTP and 24h-urinary microalbumin in the severe OSAHS group were higher than those in other groups (P<0.05); and all patients with OSAHS had higher Cyst C levels than those without OSAHS (all P<0.05). Logistic regression analysis showed that BMI (OR=1.486, 95% CI 1.022-2.160) and severe OSAHS (OR=7.138, 95% CI 1.835-27.769) were influencing factors of 24h-UTP; blood pressure (OR=2.368, 95% CI 1.324-4.234) and BMI (OR=1.678, 95% CI 1.263-2.230) were influencing factors of 24h-urinary microalbumin; age (OR=1.998, 95% CI 1.325-3.013), blood pressure (OR=3.202, 95% CI 1.319-7.773) and severe OSAHS (OR=5.462, 95% CI 1.103-27.041) were influencing factors of Cyst C. Conclusion: OSAHS is a risk factor for early renal damage in patients with hypertension. Age, BMI, blood pressure and severe OSAHS may be influencing factors for renal function in hypertensive patients with OSAHS.
Key words： Sleep apnea, obstructive/diagnosis    Sleep apnea, obstructive/complications    Hypertension/etiology    Proteinuria/urine    Albuminuria/urine    Kidney/physiopathology    Retrospective studies
收稿日期: 2015-10-14
CLC:  R5  
基金资助:

新疆维吾尔自治区自然科学基金（2015211C038）
通讯作者: 陈玉岚(1972-),女,博士,主任医师,硕士生导师,从事高血压及相关疾病的临床和基础研究;E-mail:sheliachen@sina.com;http://www.orcid.org/0000-0001-6806-9897     E-mail: sheliachen@sina.com
作者简介: 蒋倩倩(1986-),女,硕士,住院医师,从事心血管内科学临床工作;E-mail:1227935470@qq.com;http://www.orcid.org/0000-0002-8338-4120
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引用本文:

蒋倩倩 等. 高血压伴阻塞性睡眠呼吸暂停低通气综合征患者肾功能影响因素分析[J]. 浙江大学学报（医学版）, 2016, 45(3): 261-267.
JIANG Qianqian, ZHULEPIYA Simayi, CHEN Yulan, ZHOU Xiaohuan, ZHANG Xiangyang, XU Xinjuan, YE Hong. Influencing factors of renal function in hypertensive patients with obstructive sleep apnea-hypopnea syndrome. Journal of ZheJiang University(Medical Science), 2016, 45(3): 261-267.

链接本文:

http://www.zjujournals.com/xueshu/med/CN/10.3785/j.issn.1008-9292.2016.05.07      或      http://www.zjujournals.com/xueshu/med/CN/Y2016/V45/I3/261

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