2型糖尿病患者肺功能的变化与血糖控制状态的关系

Relationship between lung function and blood glucose control in type 2 diabetic patients

目的分析2型糖尿病患者肺功能的变化与血糖控制状态的关系。方法选取肺通气功能和肺弥散功能正常的2型糖尿病患者30例作为试验组，30例健康人作为健康对照组。试验组每天4次皮下注射常规胰岛素，强化血糖控制3个月；继以每天2次皮下注射预混胰岛素（诺和灵30R或50R，或优泌林70／30）治疗3个月。在治疗前、治疗后3个月、治疗后6个月分别检测肺通气功能和肺弥散功能指标以及空腹血糖（FBG）、餐后2h血糖（2h PG）、糖化血红蛋白A1c（GHbA1c）。健康对照组测定肺通气和肺弥散功能指标。结果试验组在治疗后3个月、6个月肺通气功能指标、肺弥散功能指标、FBG、2hPG分别与治疗前比较，差异均无统计学意义（P〉0．05）；治疗后3个月、6个月GHbA1c比治疗前均显著下降[（7．2±1．0）％、（7．4±2．0）％比（8．4±1．4）％，P〈0．05]。试验组治疗前肺通气及肺弥散功能指标与健康对照组差异无统计学意义（P〉0．05）；治疗后3个月、6个月试验组除单位肺泡容积一氧化碳弥散量（DLCO／VA）显著低于健康对照组（P〈0．05）外，肺通气和肺弥散功能其它指标与健康对照组比较差异均无统计学意义（P〉0．05）。结论2型糖尿病患者在短期（3～6个月）使用胰岛素强化血糖控制期间，肺通气功能没有明显改变，但反映单个肺泡弥散量的弥散常数则较正常人明显下降。

Objective To study the relationship between lung function and blood glucose control in type 2 diabetic patients. Methods Thirty type 2 diabetic cases with normal ventilatory function and diffusive function and 30 healthy people were enrolled in the study. Subcutaneous injection of insulin 4 times every day was provided to attain ideal plasma glucose target in the first 3 months. And in the later 3 months subcutaneous injection of premix insulin （Novolin 30R or 70R, insulin 70/30） twice daily was prescribed. Ventilatory function and diffusive function were measured at three time points ： before treatment, three months later and six months later. At the same time, FBG,2h PG and GHbAlc were recorded. Ventilatory function and diffusive function of 30 healthy individuals were measured at the same time. Results No significant differences were seen after 3 months and 6 months of treatment in trial group, referring to ventilatory function, diffusive function indexes, FBG and 2h PG（ P 〉 0.05 ）. The levels of GHbA1 c after 3 months and 6 months [ （7.2 ±1.0）% ,（7.4 ±2.0% ） ]were lower than before treatment（8. 4 ± 1.4% ）in trial group（P 〈 0.05）. There were no significant differences of ventilatory function and diffusive function indexes between trial group before treatment and control group （ P 〉 0.05 ）. However, DLCO/VA of diabetic patients was significantly lower than that of control group when compared at 3 months or 6 months after treatment （ P 〈 0. 05）. No significant differences were seen of ventilatory function and other diffusive function indexes between 2 groups（P 〉 0.05）. Conclusion The ventilatory function of type 2 diabetic patients does not change significantly under relative strict blood glucose control for short period, as for 3 - 6 months, but the DLCO/VA decreases significantly as compared to healthy control.