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

摘要： 背景　既往研究显示2型糖尿病与阻塞性睡眠呼吸暂停低通气综合征（OSAHS）密切相关，且在终末期肾脏疾病患者中OSAHS的患病率明显升高。然而目前关于OSAHS与2型糖尿病患者早期肾损害之间的关系研究较少。目的　探讨肥胖2型糖尿病患者缺氧指标与早期肾损伤的相关性。方法　选取2015年11月—2017年11月于徐州医科大学附属淮安医院内分泌科住院的肥胖2型糖尿病患者94例。通过查阅病历的方法收集患者一般资料，通过实验室检查收集患者血生化、尿液等指标，通过为患者配戴便携式多导睡眠呼吸监测仪（PSG）获取呼吸睡眠相关指标，并进行超声肝脏脂肪含量（LFC）测定。根据患者尿微量清蛋白与肌酐比值（ACR）将患者分为有DN组（ACR>30 mg/g，n=34）、无DN组（ACR≤30 mg/g，n=60）。比较两组患者一般资料、实验室检查指标等，采用相关分析探讨ACR与OSAHS参数指标及其他临床资料间的相关性，采用多元线性回归分析探讨ACR的影响因素。结果　两组患者男性比例、高血压史、血肌酐（Scr）、估算肾小球滤过率（eGFR）、肝脏脂肪含量（LFC）、呼吸暂停低通气指数（AHI）、氧减饱和度指数（ODI）、平均血氧饱和度（MPO2）、血氧饱和度低于90%的时间占监测总时间的百分比（CT<90%）比较，差异有统计学意义（P<0.05）；两组患者年龄、糖尿病病程、吸烟饮酒史、体质指数（BMI）、腰围（WC）、空腹血糖（FPG）、糖化血红蛋白（HbA1c）、收缩压（SBP）、舒张压（DBP）、总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、血尿素氮（BUN）、尿酸（UA）、ACR、最低动脉血氧饱和度（LSaO2）、阻塞性睡眠呼吸暂停低通气综合征（OSAHS）严重程度比较，差异无统计学意义（P>0.05）。相关分析结果显示，ACR与eGFR、AHI、ODI、LSaO2、MPO2、LFC有相关性，差异有统计学意义（P<0.05）；与年龄、SBP、DBP、WC、FPG、HbA1C、TC、TG、HDL-C、LDL-C、UA、CT<90%无相关性，差异无统计学意义（P>0.05）。多元线性回归结果显示，AHI、ODI、LSaO2、MPO2、LFC为ACR的影响因素（P<0.05）。结论　ACR与AHI、ODI、LFC呈正相关，与eGFR、LSaO2、MPO2呈负相关。AHI、ODI为ACR的独立危险因素，LSaO2、MPO2为其保护性因素。改善OSAHS缺氧指标以及降低肝脏脂肪含量，对防治早期糖尿病肾病的发生发展具有一定的临床参考意义。

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