|
|
|
| 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 |
|
|
|
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.
|
|
Received: 14 October 2015
|
|
|
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
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
|
|
| [[1]] |
ELMASRY A, LINDBERG E, HEDNER J, et al. Obstructive sleep apnoea and urine catecholamines in hypertensive males: a population-based study[J]. Eur Respir J, 2002, 19(3):511-517.
|
|
|
| [[2]] |
李南方,陈维平,严治涛,等. 睡眠呼吸暂停相关性高血压靶器官损害的调查分析[J].中华高血压杂志, 2011, 19(7): 642-646. LI Nanfang, CHEN Weiping, YAN Zhitao, et al. Investigation and analysis of target organ damage in sleep related hypertension[J]. Chinese Journal of Hypertension, 2011, 19(7): 642-646.(in Chinese)
|
|
|
| [[3]] |
《中国高血压防治指南》修订委员会.中国高血压防治指南2010[J].中华高血压杂志,2011, 19(8): 701-743. Writing Group of 2010 Chinese Guidelines for the Management of Hypertension[J]. Chinese Journal of Hypertension, 2011, 19(8): 701-743.(in Chinese)
|
|
|
| [[4]] |
中华医学会呼吸病学分会睡眠呼吸障碍学组.阻塞性睡眠呼吸暂停低通气综合征诊治指南(2011年修订版)[J].中华结核和呼吸杂志,2012,35(1):9-12. Sleep-disordered Breathing Study Group of Chinese Thoracic Society.Guidelines for the diagnosis and treatment of obstructive sleep apnea syndrome(2011 Revision)[J]. Chinese Journal of Tuberculosis and Respiratory Disease,2012,35(1):9-12.(in Chinese)
|
|
|
| [[5]] |
Kidney disease: improving global outcomes (KDIGO) CKD work group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease[J]. Kidney Int Suppl, 2013, 3(1):1-150.
|
|
|
| [[6]] |
赖玮婧,刘芳,付平. 慢性肾脏病评估及管理临床实践指南解读——从K/DOQI到KDIGO[J].中国实用内科杂志,2013, 33(6): 448-450. LAI Weijing, LIU Fang, FU Ping. Interpretation of clinical practice guideline for the evaluation and management of chronic kidney disease:from K/DOQI to KDIGO[J]. Chinese Journal of Practical Internal Medicine, 2013, 33(6): 448-450.(in Chinese)
|
|
|
| [[7]] |
王羽,张宗久,赵明钢. 全国临床检验操作规程[M].3版. 南京:东南大学出版社, 2006: 470-471. WANG Yu, ZHANG Zongjiu,ZHAO Minggang. National guide to clinical laboratory procedures[M]. 3rd ed. Nanjing:Southeast University Press, 2006: 470-471. (in Chinese)
|
|
|
| [[8]] |
ZHANG X B, LIN Q C, DENG C S, et al. Elevated serum cystatin C in severe OSA younger men without complications[J]. Sleep Breath, 2013, 17(1): 235-241.
|
|
|
| [[9]] |
詹冰洁,钦光跃,郑艳文,等. OSAHS患者早期肾功能变化及临床意义[J].医学研究杂志,2013, 42(9):76-79. ZHAN Bingjie, QIN Guangyue, ZHENG Yanwen, et al. Early renal injury in patients with obstructive sleep apnea-hypopnea syndrome and its clinical significance[J].Journal of Medical Research, 2013, 17(1):235-241. (in Chinese)
|
|
|
| [[10]] |
邵川,鲁沈源,鼓雯静,等. 慢性间歇低氧对大鼠肾脏组织细胞形态和超微结构的影响[J]. 中国老年学杂志,2011, 11(31): 4175-4177. SHAO Chuan, LU Shenyuan, GU Wenjing, et al. Influences of chronic intermittent hypoxia on morphology and ultra structure of renal tissue in rats[J]. Chinese Journal of Gerontology, 2011, 11(31): 4175-4177.(in Chinese)
|
|
|
| [[11]] |
KIM D J, KANG H S, CHOI H S, et al. Serum cystatin C level is a useful marker for the evaluation of renal function in patients with cirrhotic ascites and normal serum creatinine levels[J]. Korean J Hepatol, 2011, 17(2): 130-138.
|
|
|
| [[12]] |
MACISAAC R J, PREMARATNE E, JERUMS G. Estimating glomerular filtration ratein diabetes using serum cystatin C[J]. Clin Biochem Rev, 2011, 32(2): 61-67.
|
|
|
| [[13]] |
万学红, 卢雪峰.诊断学[M].8版.北京:人民卫生出版社, 2013: 344-349. WAN Xuehong, LU Xuefeng. Diagnostics[M]. 8th ed. Beijing: People's Health Publishing House, 2013:344-349.(in Chinese)
|
|
|
| [[14]] |
PHILLIPS C L, CISTULLI P A. Obustructive sleep apnea and hypertension: epidemiology,mechanisms and treatment effects[J]. Minerva Med, 2006, 97(4): 299-312.
|
|
|
| [[15]] |
张菊红,李南方,索菲亚·阿不力克木,等. 高血压合并阻塞性睡眠呼吸暂停低通气综合征患者的糖代谢紊乱及胰岛素抵抗[J].中华高血压杂志,2014, 22(4): 375-379. ZHANG Juhong,LI Nanfang, SUOFEIYA abulikemu, et al. Analysis of essential hypertension with obstructive sleep apnea-hypopnea syndrome in sugar metabolic disorder and insulin resistance[J].Chinese Journal of Hypertension, 2014, 22(4): 375-379. (in Chinese)
|
|
|
| [[16]] |
朱大年, 王庭槐. 生理学[M].8版.北京:人民卫生出版社, 2013:239-253. ZHU Danian, WANG Tinghuai. Physiology[M]. 8th ed. Beijing:People's Health Publishing House, 2013:239-253.(in Chinese)
|
|
|
|
Viewed |
|
|
|
Full text
|
|
|
|
|
Abstract
|
|
|
|
|
Cited |
|
|
|
|
| |
Shared |
|
|
|
|
| |
Discussed |
|
|
|
|
