The Study On The Correlation And TCM Syndrome Between Chronic Kidney Disease And Obstructive Sleep Apnea-hypopnea Syndrome

Objective:We take the study of the correlation between chronic kidney disease(CKD)progression and obstructive sleep apnea hypopnea syndrome and the regularities of distribution of TCM syndrome aiming at providing research data for decreasing the OSAHS exacerbation factors for CKD patients,preliminary understanding the distribution regularities of TCM syndrome between CKD and OSAHS severity degree and providing relatively reliable basis for clinic treatment.Methods:Our samples were collected from the patients who were hospitalized at the department of Nephrology in Chinese PLA General Hospital Nephrology from October 2013 to July 2015 and agreed to participate in this research.All the samples are monitored by polysomnography recorder when sleeping at night for at least 7 hours and all the monitoring results will be recorded into the database.All the exam patients need fill the united questionnaires which include the patients’ western medicine clinical symptoms,TCM syndrome and lingual vessels.General clinical data is also recorded,including personal background(name,gender,age,height and weight),brief medical histor,the previous and family history,24-hour urinary protein quantity(protein,urine creatinine,glucose,sodium,potassium,etc),blood routine,blood gas analysis,blood coagulation,blood biochemistry(uric acid,creatinine,carbamide,albumin,globulin,total cholesterol,triglyceride,high levels of low density lipoprotein,low density lipoprotein,blood glucose,homocysteine,etc),cystcoming fromin,parathyroid hormone,microalbuminuria/creatinine,NAG enzyme,urine osmotic pressure and other indicators and electrocardiogram,ultrasound inspections of liver,gallbladder and kidneys.And then we set up an EXCEL database.We estimate glomerular filtration rate,eGFR and calculate the body mass index(BMI)in the formula of CKD-EPI.We make CKD staging according to K/DOQI guidelines of 2002 and define OSAHS as mild,moderate and severe on the basis of AHI and the lowest oxygen saturation at night in order to complete the clinic database.The first part: analyze the correlation of clinical indicators between AHI and CKD patients.We first selected 91 patients in accordance with the inclusion criteria from 126 patients together,calculated the eGFR and then separated the patients into four groups as Group A(eGFR≥90 ml/min·1.73m2),Group B(eGFR is 60-89 ml/min·1.73m2),Group C(eGFR is 30-59 ml/min·1.73m2)and Group D(eGFR ≤ 29ml/min·1.73m2),comparing the differences of AHI and LSaO2 among each group,and analyzing the correlation between relevant clinical indicators on AHI、LSaO2 and kidney functions with bivariate correlations and multivariate regression.Second part: analyze the TCM syndrome of CKD patients with OSAHS.We selected 61 patients according to the inclusion criteria,calculated eGFR,graded the disease level according to AHI and GFR and statistically analyzed the distributions and patterns of syndrome of patients’ TCM syndrome combining with TCM four diagnostic information questionnaires of patients.Results:1.In the first part,AHI increased significantly in Group D compared to Group A and Group B(P=0.008、P=0.012).The difference has statistical significance in Group A compared to Group D(P =0.012).After carrying out the bivariate analysis of every clinic indicators of CKD and AHI patients,it is concluded that there is correlation between eGFR,blood creatinine,carbamide,body mass index,partial pressure of oxygen,oxygen saturation,carbon dioxide,plasma fibrinogen measurements,urinary phosphorus,urinary magnesium,blood β2-microglobulin determination,serum cystatin C,high density lipoprotein,PTH and AHI.After multiple stepwise regression analysis,only GFR and partial pressure of oxygen go into the regression equation.It’s found that there is the negative correlation between AHI and eGFR in CKD patients.After carrying out the bivariate analysis of every clinic indicators of CKD and SaO2 patients,it is concluded that there is correlation between eGFR,blood creatinine,carbamide,body mass index,PH determination,carbon dioxide,24-hour urinary protein concentration,24-hour urinary protein quantification,urinary calcium,urinary phosphorus,urinary magnesium,blood β2-microglobulin determination,blood microalbuminuria determination,urine α1-microglobulin determination,the rate between microalbumin and creatinine,serum cystatin C,high-density lipoprotein and SaO2.After multiple stepwise regression analysis,only microalbuminuria determination,PH measurement and serum cystatin C go into the regression equation.It’s found that there is the negative correlation between SaO2 and Cys-C,urinary micro albumin and acid and alkali.2.Among the 61 patients cases with CKD and OSAHS,the syndrome of patients with mild OSAHS is mainly phlegm-damp;The syndrome of patients with moderate OSAHS is mainly obstruction of phlegm and stasis and kidney deficiency and the syndrome of patients with severe OSAHS is mainly obstruction of phlegm and stasis and kidney deficiency.Among the 61 patients cases combining with CKD and OSAHS,patients in CKD1-2 stage are mainly with phlegm-damp,CKD 3 stage patients are mainly with obstruction of phlegm and stasis and kidney deficiency and patients in CKD 4-5 stages are mainly with obstruction of phlegm and stasis and kidney deficiency.Conclusion:1 This study shown that there is the correlation between GFR,Cys-C of renal function and AHI,SaO2 which are the important index to diagnose and judge the severity of OSAHS.AHI increased and SaO2 decreased significantly in patients of CKD4-5(eGFR≤29ml/min·1.73m2),which indicated that there is a certain correlation between CKD and OSAHS.2 The severity degree of TCM syndrome in OSAHS is similar to CKD staging development.Patients at the early stage are mainly phlegm-damp,while those at the moderate stage are mainly obstruction of phlegm and stasis and kidney deficiency and at the severe stage they are mainly obstruction of phlegm and stasis and insufficiency in both the spleen and kidney.