摘要
目的了解老年阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者血清胱抑素c水平的变化及其影响因素，评价胱抑素c在OSAHS患者合并。肾功能损害中的诊断价值。方法收集2009年4月至2012年2月来我院呼吸科睡眠监测室行睡眠呼吸监测的年龄≥60岁老年患者，依据美国睡眠医学学会的诊断标准将其分为单纯鼾症组、轻度OSAHS组、中度OSAHS组和重度OSAHS组，并匹配每组患者年龄、性别和基础疾病后，比较各组患者血脂、血糖、肌酐、肾小球滤过率（eGFR）和胱抑素C水平，行Spearman秩相关与逐步线性回归分析与胱抑素c相关的独立危险因素。结果共收集89例老年患者，男性70例，女性29例，平均年龄（68．4±6．3）岁，其中单纯鼾症组21例、轻度OSAHS组14例，中度OSAHS组21例，重度OSHAS组33例，各组问年龄、性别、高血压和糖尿病等基础疾病、血脂、肌酐、eGFR等差异无统计学意义；与单纯鼾症组比较，重度OSAHS组的体质指数（BMI）[（24．6±5．9）kg／m。比（28．3±3．9）kg／m。]、收缩压[（122．43±16．64）mmHg比（136．55±16．14）mmHg]、舒张压[（78．10--4-9．55）mmHg比（89．18±11．92）mmHg]及血胱抑素c水平[（0．76±0．13）mg／L比（o．95±0．22）mg／L]较高（均P〈0．05）。相关分析显示，胱抑素C与呼吸暂停低通气指数（AHI）、氧减指数、肌酐、eGFR、高敏c反应蛋白相关性较好（r=0．397、0．347、0．275、-0．354、0．254，均PP〈O．05）。以胱抑素c为因变量的回归分析结果显示，仅AHI为引起胱抑素c水平升高的独立危险因素（β=0．449，P=0．000）。结论老年重度OSAHS患者血清胱抑素C水平升高，AHI是引起胱抑素c水平升高的独立危险因素，血清胱抑素C水平可作为反映OSAHS患者早期肾功能损害的指标。
Objective To investigate the change of serum cystatin C （CC） level and its clinical significance in elderly patients with obstructive sleep apnea hypopnea syndrome （OSAHS）, and to evaluate the diagnostic value of serum CC for renal impairment in elderly OSAHS patients. Methods Elderly snoring subjects （age 〉60 years） undergoing sleep apnea monitoring in our sleep laboratory were recruited. Patients were divided into simple snoring group, mild OSAHS group, moderate OSAHS group and severe OSAHS group according to the diagnostic criteria of American academy of sleep medicine. Anthropometric characteristics, lipid profiles, blood glucose, creatinine, estimated glomerular filtration rate （eGFR） and serum CC were compared between groups after age, gender and basic diseases were adjusted. The independent risk factors associated with serum CC were analyzed by Spearman＇s rank correlation and stepwise linear regression. Results Totally 89 elderly patients [70 males and 29 females, aged （68.4＋6.3） years in average~ were collected. 21 subjects were grouped as simple snoring, 14 subjects as mild OSAHS, 21 subjects as moderate OSAHS and 33 subjects as severe OSAHS. There were no differences in age, gender, basic diseases （hypertension and diabetes）, lipid profiles, creatinine and eGFR among groups. The levels of body mass index, systolic blood pressure, diastolic blood pressure and serum CC were higher in severe OSAHS group than in simple snoring group 〈（28.3±3.9） vs. （24.6±5.9）, （136.55±16.14） mm Hg vs. （122.43±16.64） mm Hg, （89. 18±11.92） mm Hg vs. （78.10±9.55） mm Hg, （0.95±0.22） mg/L vs. （0.76±0.13） mg/L, respectively, all P〈0.05]. Serum CC was significantly correlated with apnea hypopnea index （AHI）, oxygen desaturation index, creatinine, eGFR, high sensitive C reactive protein （r= 0. 397, 0. 347, 0. 275, -0. 354, 0. 254 respectively, all P〈0.05）. Regression analysis showed that AHI was an independent Factor for serum CC （B= 0. 449, P〈 0. 001）. Conclusions Serum CC level is increased in elderly patients with severe OSAHS. AHI is an independent factor for the increase of serum CC. Serum CC can be as an index for the early impairment of renal function in patients with OSAHS.
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2013年第10期1058-1061,共4页
Chinese Journal of Geriatrics
