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吕颖,刘熹,张春燕,等.短期持续正压通气对阻塞性睡眠呼吸暂停低通气综合征合并慢性肾脏疾病患者的影响[J].同济大学学报（医学版）,2017,38(2):65-68. [点击复制]
LYU Ying,LIU Xi,ZHANG Chun-yan,et al.Effects of short-term continuous positive airway pressure ventilation on chronic kidney disease in patients with obstructive sleep apnea/hypopnea syndrome[J].同济大学学报（医学版）,2017,38(2):65-68. [点击复制]

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短期持续正压通气对阻塞性睡眠呼吸暂停低通气综合征合并慢性肾脏疾病患者的影响
吕颖,刘熹,张春燕,余晨
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(同济大学附属同济医院肾内科,上海 200065;宁波大学医学院附属医院肾内科,浙江宁波 315000)

摘要:

目的探讨短期持续正压通气治疗(continuous positive airway pressure, CPAP)对阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnoea syndrome, OSAHS)合并慢性肾脏病(chronic kidney disease, CKD)患者的影响。方法回顾性分析经多导睡眠监测确诊OSAHS合并CKD患者39例资料,并对影响OSAHS患者肾小球滤过率估计值(eGFR)和尿白蛋白/肌酐比值(albumin/creatinine ratio, UACR)的危险因素进行多元线性回归分析；根据低通气指数(apnea-hypopnea index, AHI)分组,标准治疗基础上给予连续每日夜间CPAP治疗,自身前后对照比较,了解短期CPAP治疗对OSAHS合并CKD患者的影响。结果重度OSAHS患者23例,中度16例,多元线性回归分析显示eGFR和AHI(β=-0.436,P=0.001)、年龄(β=-0.319,P=0.003)、UACR(β=-0.339,P=0.005)负相关,AHI、年龄、UACR是OSAHS合并CKD患者eGFR下降的独立危险因素；UACR与平均脉搏氧饱和度(average pulse oxygen saturation, ASpO₂)负相关(β=-0.492,P＜0.001),与舒张压(β=-0.319,P=0.003)正相关,ASpO₂和舒张压是UACR增多的独立危险因素；组患者经CPAP治疗后,中度组血肌酐、eGFR得到了改善,重度组血肌酐、eGFR、UACR、尿α1-MG均明显改善。结论短期CPAP治疗可使OSAHS合并CKD患者获益。

关键词: 慢性肾脏病持续正压通气阻塞性睡眠呼吸暂停低通气综合征

DOI：10.16118/j.1008-0392.2017.02.013

投稿时间：2016-09-17

基金项目:

Effects of short-term continuous positive airway pressure ventilation on chronic kidney disease in patients with obstructive sleep apnea/hypopnea syndrome

LYU Ying,LIU Xi,ZHANG Chun-yan,YU Chen

(Dept.of Nephrology, Tongji Hospital, Tongji University, Shanghai 200065, China;Dept.of Nephrology, The Affiliated Hospital of School of Medicine of Ningbo University, Ningbo 315000, Zhejiang Province, China)

Abstract:

Objective To investigate the effects of short-term continuous positive airway pressure(CPAP) on chronic kidney disease(CKD) in patients with obstructive sleep apnea/hypopnea syndrome(OSAHS). Methods Thirty nine OSAHS patients complicated with CKD were enrolled in the study. According to the apnea-hypopnea index(AHI) patients received CPAP treatment at night on the basis of standard treatment. The factors influencing the estimated glomerular filtration rate(eGFR) and urinary albumin/creatinine ratio(UACR) were analyzed by multiple linear regression analysis； and the effect on short-term CPAP treatment on renal function of patients was also analyzed. ResultsThere were 23 cases of severe OSAHS patients and 16 cases of moderate OSAHS cases. Multiple linear regression analysis showed that eGFR was negatively correlated with AHI(β=-0.436,P=0.001), age(β=-0.319,P=0.003) and UACR(β=-0.339,P=0.005)； AHI, age and UACR were independent risk factors for decreased eGFR in OSAHS patients with CKD. UACR was negatively correlated with average pulse oxygen saturation(ASpO₂)(β=-0.492,P＜0.001) and positively correlated with diastolic blood pressure(β=-0.319,P=0.003)； ASpO₂ and diastolic blood pressure were independent risk factors of the increased UACR. After CPAP treatment, the serum creatinine and eGFR were improved in all patients, while the UACR and urinary α1-MG were significantly improved in severe OSAHS patients. Conclusion The results indicate that short-term CPAP treatment can benefit the OSAHS patients complicated with CKD.

Key words: chronic kidney disease continuous positive airway pressure obstructive sleep apnea hypopnea syndrome