Jiang Qian, Li Tao-Ping, Pang Bo, Wang Xiao, Wang Yu-Feng
Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.E-mail:
Nan Fang Yi Ke Da Xue Xue Bao. 2016 Mar;36(3):339-44.
To evaluate the association between severity of obstructive sleep apnea hypopnea syndrome (OSAHS) without chronic kidney disease (CKD) and serum cystatin C.
A total of 238 patients with snoring during sleep admitted between January 2012 and June 2015 underwent full-night polysomnography for diagnosis of OSAHS. The patients were divided according to the apnea-hypopnea index (AHI) scores into simple snoring group (AHI<5) and mild (AHI, 5-15), moderate (AHI, 15-30), and severe OSAHS (AHI>30) groups. The medical history, baseline demographic characteristics, blood glucose, blood lipids, peripheral blood cell count and serum cystatin C were measured, and the correlation between polysomnographic parameters and serum cystatin C were analyzed in different groups.
The simple snoring, mild, moderate, and severe OSAHS groups consisted of 41, 49, 56, and 92 cases, respectively. Serum cystatin C, WBC and its subtype counts, RBC count, and superoxide dismutase (SOD) were all significantly higher in severe OSAHS group than in the other 3 groups (P<0.05), but serum creatinine and estimated glomerular filtration rate were comparable among the groups (P>0.05). Linear correlation analysis revealed that serum cystatin C was positively correlated with gender, BMI, neck circumference, abdominal circumference, SBP, AHI, and WBC (P<0.01) and inversely correlated with the average pulse oxygen saturation (ASpO2), minimum pulse oxygen saturation (MSpO(2)), and SOD (P<0.01). Multiple regression analysis identified AHI and SOD as independent factors that were positively and inversely correlated with serum cystatin C (β=0.218, P<0.010; β=-0.217, P<0.009), respectively.
Severe OSAHS is closely correlated with serum cystatin C, WBC, and SOD, suggesting that severe OSAHS may initiate the pathological process of early renal damage possibly in association with chronic intermittent hypoxia-induced oxidative stress and the initiation of the inflammatory cascade.
评估无慢性肾脏病（CKD）的阻塞性睡眠呼吸暂停低通气综合征（OSAHS）严重程度与血清胱抑素C之间的关联。
选取2012年1月至2015年6月期间收治的238例睡眠打鼾患者，行全夜多导睡眠图检查以诊断OSAHS。根据呼吸暂停低通气指数（AHI）评分将患者分为单纯打鼾组（AHI<5）以及轻度（AHI，5 - 15）、中度（AHI，15 - 30）和重度OSAHS（AHI>30）组。测量病史、基线人口统计学特征、血糖、血脂、外周血细胞计数及血清胱抑素C，并分析不同组多导睡眠图参数与血清胱抑素C之间的相关性。
单纯打鼾组、轻度组、中度组和重度OSAHS组分别有41例、49例、56例和92例。重度OSAHS组的血清胱抑素C、白细胞及其亚群计数、红细胞计数和超氧化物歧化酶（SOD）均显著高于其他3组（P<0.05），但各组间血清肌酐和估计肾小球滤过率相当（P>0.05）。线性相关分析显示，血清胱抑素C与性别、体重指数（BMI）、颈围、腹围、收缩压（SBP）、AHI和白细胞呈正相关（P<0.01），与平均脉搏血氧饱和度（ASpO2）、最低脉搏血氧饱和度（MSpO2）和SOD呈负相关（P<0.01）。多元回归分析确定AHI和SOD分别为与血清胱抑素C呈正相关和负相关的独立因素（β = 0.218，P<0.010；β = -0.217，P<0.009）。
重度OSAHS与血清胱抑素C、白细胞和SOD密切相关，提示重度OSAHS可能与慢性间歇性缺氧诱导的氧化应激及炎症级联反应启动有关，从而引发早期肾损害的病理过程。
