阻塞型睡眠呼吸中止症相關於中老年男性 蛋白尿的發生：決策樹分析模式

Obstructive Sleep Apnea Associated with Proteinuria in Late Mid-Aged Male: A Decision Tree Analysis

張淑雲(Shu-Yun Chang)

指導教授 ： 丁 化

中山醫學大學/醫學院/醫學研究所/碩士(2012年)

https://doi.org/10.6834/CSMU.2012.00158

摘要

蛋白尿與阻塞型睡眠呼吸中止症 (obstructive sleep apnea, OSA) 兩者皆與心血管疾病或死亡相關。我們藉由決策樹的統計分析來檢驗阻塞型睡眠呼吸中止症是否為蛋白尿的預測因子以探討可能因族群分類的不同而有相異的結果。在此橫斷群組世代研究上，藉由人口學、血壓、血液生化分析、單一尿液試紙分析及整夜的多頻道睡眠生理檢查等資料應用於分析300名從事靜態工作的男性。結果發現:其中61位(20.3%)有蛋白尿，且經由邏輯回歸分析顯示糖化血紅素 (glycated hemoglobin, HbA1c)，動脈血氧飽和度<90%的時間長短、年齡、高敏感性C型-反應蛋白 (high-sensitive C-reactive-protein, hs-CRP) 的對數值等；但不包含睡眠呼吸障礙指數 (apnea-hypopnea index, AHI) ，僅能解釋16.7%蛋白尿的產生。而決策樹分析則顯示：年齡大於49歲者會比低或等於49歲者（即對應組）有更高的蛋白尿風險。在高於49歲的族群中，應較對應組 AHI >21次/小時會有較高的蛋白尿風險；相對地在低於等於49歲的族群中，當其HbA1c >7，或是 ≦7，但其BMI >27.4Kg/ m2 時則相對於對應組會有較高的蛋白尿風險。結論: AHI是主要的從事靜態工作的中年後期男性蛋白尿產生的唯一決定因子；而HbA1c與BMI，則是年輕男性蛋白尿產生的決定因子。經由決策樹法統計分析，本研究利用階層分級模式併全方位多因子考量，應更能了解蛋白尿的相關聯因子。

關鍵字

呼吸中止和呼吸不足指標 ； 尿液試紙標定 ； 微量蛋白尿 ； 睡眠呼吸障礙 ； 代謝症候群

並列摘要

Proteinuria or obstructive sleep apnea (OSA) was associated with cardiovascular events and mortality. To examine whether OSA is a potential predictor of proteinuria, a data-driven analysis was performed to delineate a potential categorical classification algorithm. In this cross-sectional community-based cohort study, demographic data, blood pressures, serum biochemical analyses, proteinuria via single dipstick urinalysis, and overnight polysomnography were measured in 300 males with sedentary work styles. 61 (20.3%) of 300 participants had proteinuria. Logistic regression analysis showed that glycated hemoglobin (HbA1c), duration of arterial-oxygen-saturation <90%, age, and log high-sensitive C-reactive-protein, but not apnea-hypopnea index (AHI), were responsible for a mere 16.7% of the variance of proteinuria’s presence. A decision tree analysis showed that subjects with age >49 years had a higher risk for proteinuria than ≦49, the counterpart. In the age >49 group, subjects with AHI >21 events/hour had a higher risk for proteinuria; whereas in age ≦49 group, subjects with HbA1c >7%, or with HbA1c ≦7 and body mass index (BMI) >27.4 kg/m2 had a higher risk for proteinuria than their counterparts. AHI was the sole determinant responsible for the presence of proteinuria in late mid-aged male sedentary workers, while HbA1c and BMI were in the juniors. By algorithm analysis, this study provides a comprehensive hierarchical model for better understanding the correlates of proteinuria.

並列關鍵字

anea-hypopnea index ； dipstick urinalysis ； microalbuminuria ； sleep disordered breathing ； metabolic syndrome

參考文獻

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