2型糖尿病患者的肺功能变化及其相关因素分析
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摘要
目的:探讨2型糖尿病患者肺功能变化及其相关因素。方法:用肺功能指标测定入选74例2型糖尿病患者(糖尿病组)的肺功能并同时测定甘油三脂、胆固醇、C反应蛋白、同型半胱氨酸、脂蛋白a、空腹血糖、空腹胰岛素、糖化血红蛋白(HbA1c)检查以及尿蛋白排泄率(AER)检测、眼底检查以及神经传导速度检查,计算胰岛素抵抗指数;74例无糖尿病患者为对照组完成9个月的观察,比较两组肺功能变化,并对糖尿病组肺功能变化的相关因素进行多因素线性回归分析。结果:糖尿病组肺活量(VC)、1s用力呼气容积(FEV1)、肺总量(TLC)、最大自主通气量(MVV)、肺一氧化碳弥散量(DLCO)、肺单位体积一氧化碳弥散量(KCO)均明显低于对照组(P<0.05)。对糖尿病组进行线性相关分析表明,VC、FEV1、TLC均与HbA1c呈负相关(P<0.01),且VC与同型半胱氨酸呈负相关(P<0.05), MVV与微血管并发症积分呈相关性(P<0.01)。DLCO、KCO均与HbA1c、微血管并发症积分呈负相关(P<0.05),DLCO亦与胰岛素抵抗指数呈负相关(P<0.05),并对糖尿病患者肺功能指标与多种相关因素进行多因素线性回归分析。结论:2型糖尿病患者存在肺通气功能及弥散功能减退,肺脏可能是糖尿病慢性病变的靶器官之一,控制血糖、改善胰岛素抵抗、抗氧化应激治疗是其防治重点。
Objective:To investigate the changes of pulmonary function in patients with type 2 diabetes and its related factors. Methods: 74 cases with type 2 diabetes patients(diabetes group) were selected according to pulmonary function test .Triglyceride, total cholesterol, C-reactive protein, homocysteine, lipoprotein-a, glycosylated hemoglobin (HbA1c), urine albumin excretion rate(AER),fundus examination and nerve conduction velocity, insulin resistance index were detected in 74 patients with type 2 diabetes.All cases were observed in nine months while 74 cases of nondiabetic as control subjects,two groups’pulmonary function were compared,related factors of type 2 diabetes were analyzed by multiple linear regression analysis.Results:Compared with the control group, vital capacity(VC),forced expiratory volume in first second(FEV1),total lung capacity(TLC),maximal voluntary ventilation(MVV),diffusion capacity for carbonmonoxide of lung(DLCO)and diffusion capacity for carbon monoxide per liter of alveolar volume(KCO)were significantly decrease in the type 2 diabetic group(P<0.05).Liner regression analysis showed that VC、FEV1、TLC、DLCO、KCO were negative correlated with HbA1c,VC was negative correlated with homocysteine.(P<0.05),maximal voluntary ventilation(MVV)、DLCO、KCO were negative correlated with complication integra(P<0.05).DLCO was negative correlated with insulin resistance index(P<0.05). Conclusion:The patients of type 2 diabetes exist abnormal pulmonary ventilatory function and diffusive function,which imply that the lung might be the target organ in the chronic pathologic changes of diabetes.Glycemic control,ameliorating insulin tesistance and anti-oxidative stress therapy are the emphasis of the prevention and therapy .
Objective:To investigate the changes of pulmonary function in patients with type 2 diabetes and its related factors. Methods: 74 cases with type 2 diabetes patients(diabetes group) were selected according to pulmonary function test .Triglyceride, total cholesterol, C-reactive protein, homocysteine, lipoprotein-a, glycosylated hemoglobin (HbA1c), urine albumin excretion rate(AER),fundus examination and nerve conduction velocity, insulin resistance index were detected in 74 patients with type 2 diabetes.All cases were observed in nine months while 74 cases of nondiabetic as control subjects,two groups’pulmonary function were compared,related factors of type 2 diabetes were analyzed by multiple linear regression analysis.Results:Compared with the control group, vital capacity(VC),forced expiratory volume in first second(FEV1),total lung capacity(TLC),maximal voluntary ventilation(MVV),diffusion capacity for carbonmonoxide of lung(DLCO)and diffusion capacity for carbon monoxide per liter of alveolar volume(KCO)were significantly decrease in the type 2 diabetic group(P<0.05).Liner regression analysis showed that VC、FEV1、TLC、DLCO、KCO were negative correlated with HbA1c,VC was negative correlated with homocysteine.(P<0.05),maximal voluntary ventilation(MVV)、DLCO、KCO were negative correlated with complication integra(P<0.05).DLCO was negative correlated with insulin resistance index(P<0.05). Conclusion:The patients of type 2 diabetes exist abnormal pulmonary ventilatory function and diffusive function,which imply that the lung might be the target organ in the chronic pathologic changes of diabetes.Glycemic control,ameliorating insulin tesistance and anti-oxidative stress therapy are the emphasis of the prevention and therapy .
引文
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[2]汤秀英,王昱,王书合,等.糖尿病大鼠肺的超微结构观察及形态计量学研究.中国体视学与图像分析,2007,12(2):126-128..
[3]郝新忠,陈隽,杨妤欣,等.2型糖尿病大鼠活化肺泡CD14表达及TNF-a、IL-6分泌减少.中国糖尿病杂志,2006,14:52- 55.
[4]张放,刘秀娟,康健,等.糖尿病大鼠肺泡巨噬细胞功能变化及胰岛素治疗的影响.中华结核和呼吸杂志,2008,31(3):231- 232.
[5] Royle P, Waugh N, McAuley L, et al. Inhaled insulin in diabetes mellitus[J]. Cochrane Database Syst Rev, 2003,(3):CD003890.
[6] Sinha S,Guleria R,Misra A,et al.Pulmonary functiongs in patients with type 2 diabetes mellitus& correlationg with anthropometry µvascular complications.Indina J Med Res,2004,119:66-71.
[7]邓丹阳.2型糖尿病患者肺功能变化与血糖水平.河北医学,2006,28(7):578- 579.
[8]冯爱萍,马德堂,石云,等.II型糖尿病患者肺功能改变及相关因素分析.河北医学,2005,11(8):699- 701.
[9] Carlos A,Benbassat,Stem E,et al. Pulmonary function in pa2tients with diabetes mellitus. Am J Med Sci,2005,322(3):127.
[10]覃国珍,戚莹.2型糖尿病患者肺功能改变及影响因素研究[J].内科,2009,4(4):527-529.
[11]Ziemer DC,et al.An intervention to overcome clinical inertia and improves mellitus control in a primary care setting:improving Primary Care of African Americans with Diabetes(IPCAAD) 8[J].Arch Intern Med,2006,166(5):507-513.
[12]Landis SE,et al.North Carolina family medicine residency programs’diabetes learning collaborative[J].Fam Med,2006,38(3):190-195.
[13]Moolasarn S,et al.Usage of and cost of complementary/alternative medicine in diabetic patients[J].J Med Assoc Thai,2005,88(11):1630-1637.
[14]Harris M, Klein RE, Welborn TA, Knuiman MW: Onset of NIDDM occurs at least 4–7 yrs before clinical diagnosis. Diabetes Care 1992 15:815–819,
[15]Wendy A. Davis, MPH, Matthew Knuiman, et al. Glycemic exposure Is associatedwith reduced pulmonary function in type 2 Diabetes[J] Diabetes Care, 2004,(27):752-757,
[16]Meo SA, Al-Drees AM,Arif M,Mshah FA,Al-Rubean K.Assessment of respirator FAmuscles endurance in diabetic patience. Saudi Med J.2006, Feb;27(2):223-6.
[17]Benbassat CA,Stern E,Kramer M,et al.Pulmonary function in patients with diabetes mellitus[J].Am J MedSci,2001,322(3):127-32.
[18]Guvener N,Tuncu NB,Akcay S,et al.Alveolar gas exchange in patients with type 2 diabetes mellitus [J].Endocr J,2003,50(6):663-7
[19]智睿,丁玉江,杜坚.12型糖尿病患者肺功能状态观察[ J] .中国糖尿病杂志, 2000, 8( 4) : 253～254.
[20]Goldman MD.Lung dysfunction in diabetes[J].Diabetes Care,2003,26(6):1915-8.
[21]Kodolova I M,Lysenko L V.Saltykov B B.Changes in the lungs in diabetes mellitus[J].Arkh Patol,1982,44(7):35-40.
[22]沈兴平,舒昌达,何军,等.实验性糖尿病肺细胞外基质免疫组织化学研究.中国糖尿病杂志,2000,8(3):171-174.
[23]沈兴平,舒昌达,何军.实验性糖尿病肺iNOS和VIP免疫组织化学观察及图像分析[J].中国病理生理杂志,2001,17(10):1008.
[24]Antonelli Incalzi R, Fuso L, Pitocco D, Basso S, TrovéA, Longobardi A, Calcagni ML, Giordano A, Ghirlanda G. Decline of neuroadrenergic bronchial innervation and respiratory function in type 1 diabetes mellitus: a longitudinal study. Diabetes Metab Resv.2007 May;23(4):311-6.
[25]江山平,黄莉文,李依群,等.2型糖尿病患者的肺功能改变.中华结核和呼吸杂志,200528(1):65-66.
[26]Boulbou MS, Gourgoulianis KI, Petinaki EA, et al. Pulmonary function and circulating adhesion molecules in patients with diabetes mellitus [ J ]. Can Resp ir J, 2003, 10 (5) : 259 - 264.
[27]马学毅,杨明功,邓大同,等.糖化血红蛋白与糖化血清蛋白.现代糖尿病诊断治疗学,2007,116-128.
[28]赵桂华,潘金兵,王焕霞,等.糖尿病患者肺功能分析.医药论坛杂志,2007,28(18):75- 76.
[29]余明业,郑永克,叶绍茗.63例2型糖尿病肺弥散功能变化的临床观察.福建医药杂志,2007,27(2):62- 63.
[30]Chance WW, Rhee C,Yilmaz C, Dane DM,Pruneda ML,Hsia CC. Diminished alveolar microvascular reserves in type 2 diabetes reflect systemic microangiopathy.Diabetes Care. 2008 Aug 31(8):1596-601.
[31]Weynand B,Jonckheere A,Frans A,ed al.Diabetes mellitus induces thickening of the pulmonary basal lamina.Respiration,1999,66(1):14.
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