关键词: 肥胖症；糖尿病, 2型；肾损伤；睡眠呼吸暂停, 阻塞性；低通气综合征

Abstract: Background　Previous studies have shown that type 2 diabetes is closely associated with obstructive sleep apnea hypopnea syndrome （OSAHS），a syndrome with a significantly elevated probability of being found in end-stage renal disease.However，there are few studies on the relationship between OSAHS and early renal damage in patients with type 2 diabetes.Objective　To explore the association between OSAHS-related parameters and early renal damage in obese patients with type 2 diabetes.Methods　Ninety-four obese type 2 diabetes inpatients were recruited from Endocrinology Department，the Affiliated Huaian Hospital of Xuzhou Medical University from November 2015 to November 2017.Their general personal data were collected by reviewing medical records，and biochemical and urine indicators were collected through laboratory tests.Respiratory parameters monitored with the portable polysomnography，and liver fact content（LFC） determined by quantitative hepatic fat ultrasonography were also collected.According to the urinary albumin/creatinine ratio （ACR），patients were divided into DN group （ACR>30 mg/g，n=34） and non-DN group （ACR≤30 mg/g，n=60）．Comparisons of the general personal data and laboratory indicators of both groups were performed.Correlation analysis was used to explore the correlation of ACR with OSAHS parameters and other clinical data.Multiple linear regression analysis was used to explore the influencing factors of ACR.Results　（1） There were significant differences in male ratio，hypertension history，serum creatinine （Scr），estimated glomerular filtration rate （eGFR），LFC，apnea-hypopnea index （AHI），oxygen desaturation index（ODI），mean oxygen saturation（MPO2） and cumulative time percentage with SPO2 <90% （CT<90%） between the two groups （P<0.05）．There were no significant differences in the average age，and duration of diabetes，rates of having smoking and drinking history，average BMI，waist circumference（WC），fasting plasma glucose（FPG），glycated hemoglobin （HbA1c），systolic blood pressure （SBP），diastolic blood pressure（DBP），total cholesterol （TC），triglyceride（TG），low-density lipoprotein cholesterol （LDL-C），high-density lipoprotein cholesterol （HDL-C），blood urea nitrogen（BUN），uric acid （UA），ACR，and lowest oxygen saturation （LSaO2） and the severity of OSAHS between the two groups （P>0.05）．（2） Correlation analysis showed that ACR was significantly associated with eGFR，AHI，ODI，LSaO2，MPO2 and LFC（P<0.05），but had no correlation with age，SBP，DBP，WC，FPG，HbA1c，TC，TG，HDL-C，LDL-C，UA and CT<90%（P>0.05）．（3） Multiple linear regression analysis showed that AHI，ODI，LSaO2，MPO2 and LFC were independent factors significantly associated with ACR（P<0.05）．Conclusion　ACR was positively correlated with AHI，ODI，and LFC，and negatively correlated with eGFR，LSaO2，and MPO2.Increased AHI and low ODI are independent risk factors for ACR，while elevated LSaO2 and MPO2 are its protective factors.Improving OSAHS status and reducing LFC may have certain clinical significance for the prevention and treatment of early diabetic nephropathy.

Key words: Obesity；Diabetes mellitus, type 2；Kidney injury；Sleep apnea, obstructive；Hypoventilation syndrome