老年重叠综合征患者早期肾损伤临床研究

Clinical study of early renal injury in elderly patients with overlap syndrome

摘要:

目的 探讨重叠综合征(OS)早期肾损伤情况及相关指标分析。方法 选取2014年1月至2018年8月南京市第一医院呼吸与危重症医学科收治的16例OS患者(OS组)及42例慢性阻塞性肺疾病(COPD)患者(COPD组),另选取同期不伴有缺氧性疾病的健康体检者30名(对照组)。分别测定各组肺功能指标1秒钟用力呼气容积占预计值百分比(FEV1%)、用力肺活量占预计值百分比(FVC%)和1秒钟用力呼气容积/用力肺活量(FEV1/FVC),血气分析指标氧分压(PaO₂)及二氧化碳分压(PaCO₂),肾功能指标血清尿素氮(BUN)、血肌酐(SCr)、内生肌酐清除率(Ccr)、胱抑素C(Cys-C)及β₂微球蛋白(β₂-MG)水平。比较各组指标差异。采用SPSS 22.0软件进行统计分析。根据数据类型,组间比较采用方差分析、LSD两两比较或χ²检验。Spearman秩相关法对Cys-C和β₂-MG与其他指标进行相关性分析。结果 与对照组比较,OS和COPD组患者COPD评估测试(CAT)评分、PaCO₂、Cys-C及β₂-MG显著升高,PaO₂、FEV1%、FVC%和FEV1/FVC显著降低,差异有统计学意义(P＜0.05),但3组BUN及SCr及Ccr差异无统计学意义(P＞0.05)。与COPD组比较,OS组患者CAT、Cys-C及β₂-MG显著升高,差异有统计学意义(P＜0.05)。相关性分析显示,Cys-C和β₂-MG与CAT评分呈正相关(Cys-C:r=0.722,P=0.000；β₂-MG:r=0.287,P=0.029),与PaO₂呈负相关(Cys-C:r=-0.355,P=0.006；β₂-MG:r=-0.471,P=0.000),差异均有统计学意义。结论 通过检验OS患者血清Cys-C和β₂-MG水平可以监测早期肾损伤程度,并且Cys-C和β₂-MG水平和缺氧密切相关。

Abstract:

Objective To investigate early renal injury in overlap syndrome (OS) and related indicators. Methods Enrolled in the study were 16 patients with OS (OS group) and 42 with chronic obstructive pulmonary disease (COPD; COPD group) treated in the Department of Respiratory and Critical Care Medicine of Nanjing First Hospital from January 2014 to August 2018. During the same period, 30 healthy people without hypoxic diseases were enrolled as control group. Measurement was made of the pulmonary indicators [percentage of predicted forced expiratory volume in 1 second (FEV1%), percentage of predicted forced vital capacity (FVC%), forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC)], blood gas analysis [partial pressure of oxygen (PaO₂) and partial pressure of carbon dioxide (PaCO₂)], indicators of renal function [blood urea nitrogen (BUN), serum creatinine(SCr), endogenous creatinine clearance rate (Ccr), cystatin C(Cys-C) and β₂-microglobulin (β₂-MG)]. The difference of the parameters among groups was observed. SPSS statistics 22.0 was used for statistical analysis. According to the data type, analysis of variance (ANOVA), LSD pairwise comparison or χ² test was used for comparison among groups, and Spearman rank correlation for the correlation between Cys-C or β₂-MG and other indicators. Results The OS and COPD groups scored significantly higher than the control group in COPD assessment test (CAT), PaCO₂, Cys-C and β₂-MG but significantly lower in PaO₂, FEV1%, FVC% and FEV1/FVC (P<0.05), but there were no significant differences in BUN, SCr and Ccr among the three groups (P>0.05). Compared with the COPD group, CAT, Cys-C and β₂-MG in the OS group were significantly higher(P<0.05). The correlation analysis showed that Cys-C and β₂-MG were positively correlated with CAT score(Cys-C:r=0.722,P=0.000；β₂-MG:r=0.287, P=0.029)and negatively correlated with PaO₂(Cys-C:r=-0.355, P=0.006；β₂-MG:r=-0.471, P=0.000), all with statistical significance(P<0.05).Conclusion Measurement of serum Cys-C and β₂-MG in OS patients can help monitor the degree of early renal injury, and Cys-C and β₂-MG are closely associated with hypoxia.