Effects Of Contrast Media On Obstructi Ve Sleep Apnea Hypopnea Syndrome And Chronic Obstructive Pulmonary Disease

Background: In recent years,with the wide application of contrast agents in angiography,enhanced CT and vascular CT angiography,contrast induced nephropathy is more and more common.For ordinary people,moderate use of contrast media is not enough to cause contrast induced nephropathy.For patients with chronic obstructive pulmonary disease(COPD)and obstructive sleep apnea hypopnea syndrome(OSAHS),there are different degrees of ischemia and hypoxia in renal tissue.The application of contrast media has the potential risk of aggravating renal injury.Objective: To investigate the influence of the type of disease,the severity of the disease and the dose of contrast medium on renal function in patients with COPD-OSAHS overlap by contrast examination,so as to provide the basis for the prevention of contrast nephropathy in copd-osahs overlap patients.Methods: Patients with chest pain,dyspnea or pulmonary space occupying in the Department of respiratory medicine of people’s Hospital Affiliated to Hubei Medical College from January 2019 to December 2020 were selected as the case group,and they were divided into COPD group(n = 40),OSAHS group(n = 35)and COPD-OSAHS overlapping group according to the results of pulmonary function examination and polysomnography(PSG)The healthy control group(n = 40)was composed of healthy people who had no COPD and / or OSAHS related symptoms in our hospital during the same period.Serum creatinine(SCR),urea nitrogen(BUN),Cystatin C(Cys C),endogenous creatinine clearance rate(CCR)and urinary α1-microglobulin(α1-MG)were measured.The changes of the above indexes were observed before and 24 h,72 h and 7 d after angiography in the case group.The incidence of contrast induced nephropathy(CIN)was calculated at the time when SCR increased the most.The changes of SCR,bun,Cys C,CCR,α1-MG and the incidence of CIN were compared in different disease groups,different dose groups,different degree groups and different time periods after angiography.Results : 1.Compared with healthy control group,SCR and bun of COPD,OSAHS and COPD-OSAHS groups before angiography had no significant difference(P > 0.05),but Cys C and α1-MG increased slightly and CCR decreased;compared with OSAHS group and COPD group,Cys C,α1-MG increased and CCR decreased more significantly in COPD-OSAHS Overlap Group(P<0.05).2.Bun,SCR,Cys C and α1-MG increased and CCR decreased in COPD,OSAHS and COPD-OSAHS overlap groups after angiography,especially in COPD-OSAHS group(P<0.05);the incidence of CIN in three groups was 2.86%,2.50% and 10.71%,respectively(P<0.05).3.In the case group,bun,SCR,Cys C,α1-MG and CCR at 72 h after angiography were the most obvious changes,and the incidence of CIN was the highest,the difference was statistically significant(P<0.05).4.In the case group,the changes of bun,SCR,Cys C,α1-MG and CCR in the high-dose contrast group were more obvious than those in the medium and low-dose contrast groups,and there was a doseresponse relationship with the damage of renal function,and the difference was statistically significant(P<0.05).5.In the case group,with the aggravation of the disease,the renal function damage after angiography was more obvious,and the incidence of CIN was higher,the difference was significant(P<0.05).Conclusion : 1.In COPD,OSAHS,COPD-OSAHS overlap patients,there are potential,basic damage of renal function,Cys C,α1-MG and CCR as indicators of renal function damage,the sensitivity is higher than the traditional bun,SCR.2.The use of contrast media may aggravate the damage of renal function in patients with OSAHS,COPD and COPD-OSAHS overlap,especially in patients with COPDOSAHS overlap.3.In patients with COPD,OSAHS and COPD-OSAHS overlap,the effect of contrast agent on renal function is most obvious72 hours after contrast examination,which should be detected early and intervened in time.4.The dose of contrast agent and the severity of the disease are closely related to the occurrence of contrast agent renal injury.Therefore,the use of contrast agent should be avoided or reduced in patients with OSAHS and COPD,especially in patients with severe COPD-OSAHS overlap.