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目的研究住院2型糖尿病合并阻塞性睡眠呼吸暂停征(OSAS)患者肾脏合并症情况。方法收集符合条件的2型糖尿病患者,记录年龄、病程、体重指数、腰围、血压等指标,使用便携式睡眠呼吸监测仪进行睡眠呼吸监测,同时完善糖化血红蛋白、空腹血糖、餐后2小时血糖、肌酐、尿素氮、24小时尿微量白蛋白及尿蛋白检验,并计算肾小球滤过率。结果完成研究106例,71例合并OSAS。合并OSAS的患者肌酐(64.49±15.72μmol/L vs 57.28±8.69μmol/L,P<0.05)、尿素氮(5.04±0.61mmol/L vs 4.71±0.64mmol/L,P<0.05)、24小时尿微量白蛋白[25.30(12.64,68.70)mg vs 8.74(4.8,16.24)mg,P<0.05]及24小时尿蛋白[0.24(0.1,1.45)g vs 0.15(0.06,0.26)g,P<0.05]高于未合并OSAS患者,合并OSAS患者肾小球滤过率(89.83±13.97mL·min~(-1)·1.73m~(-2)vs 102.88±8.02mL·min~(-1)·1.73m~(-2),P<0.05)偏低。合并OSAS的患者中,出现Ⅲ期以上糖尿病肾病比未合并OSAS的患者更多见(53.5%vs46.5%,P<0.05)。采用多因素logistics回归分析后发现,糖化血红蛋白(OR1.36,95%CI 1.01~1.07,P<0.05),空腹血糖(OR1.01,95%CI0.73~1.16,P<0.05)及每小时睡眠呼吸暂停次数(AHI)(OR 1.1 1,95%CI 1.00~1.23,P<0.05)与Ⅲ期以上糖尿病肾病患病独立相关。结论合并OSAS的2型糖尿病患者肾脏功能下降更明显,更容易出现肾脏并发症,OSAS是糖尿病肾脏病变的独立危险因素。
Objective To study the incidence of kidney complications in hospitalized type 2 diabetic patients with obstructive sleep apnea syndrome (OSAS). Methods Patients with type 2 diabetes mellitus were collected and their age, course of disease, body mass index, body mass index, waist circumference and blood pressure were recorded. Sleep apnea was monitored by portable sleep apnea monitor. At the same time, glycemic hemoglobin, fasting blood glucose, , Urea nitrogen, 24-hour urine microalbumin and urine protein test, and calculate the glomerular filtration rate. Results The study completed 106 cases, 71 patients with OSAS. Creatinine in patients with OSAS (64.49 ± 15.72μmol / L vs 57.28 ± 8.69μmol / L, P <0.05), urea nitrogen (5.04 ± 0.61mmol / L vs 4.71 ± 0.64mmol / L, P <0.05) P <0.05] and 24-hour urinary protein [0.24 (0.1,1.45) g vs 0.15 (0.06,0.26) g, P <0.05] Glomerular filtration rate (89.83 ± 13.97mL · min -1 · 1.73m -2 vs 102.88 ± 8.02mL · min -1 · 1.73) in patients with OSAS were significantly higher than those without OSAS m -2, P <0.05). Patients with OSAS were more common in patients with stage III diabetes than those without OSAS (53.5% vs 46.5%, P <0.05). After using multivariate logistic regression analysis, the levels of HbA1c (OR1.36, 95% CI 1.01-1.07, P <0.05), fasting blood glucose (OR1.01, 95% CI 0.73-1.16, P <0.05) and hourly The number of sleep apnea episodes (OR1.1, 95% CI 1.00-1.23, P <0.05) was independently associated with the prevalence of stage III diabetic nephropathy. Conclusions Patients with type 2 diabetes mellitus combined with OSAS have a more pronounced decrease in renal function and are more likely to have kidney complications. OSAS is an independent risk factor for diabetic nephropathy.