主动吸烟、被动吸烟与2型糖尿病伴慢性肾脏病的关系

Effects of active and passive smoking on chronic kidney disease in patients with type 2 diabetes mellitus

目的 研究不同吸烟状态对2型糖尿病（T2DM）患者尿白蛋白及GFR的影响.方法 入选705例住院的T2DM患者,测定24h尿白蛋白,计算GFR,采用标准问卷收集吸烟状态,并将所有研究对象分为不吸烟、主动吸烟及被动吸烟3组.同时测定研究对象各项人体参数及糖、脂代谢指标.结果 （1） T2DM患者伴慢性肾脏病（CKD）的患病率为31.63％ （223/705）.男性T2DM患者中,不吸烟、被动吸烟、主动吸烟的CKD患病率分别为28.6％（22/77）、30.0％（15/50）、29.6％（73/247）;女性T2DM患者中,不吸烟、被动吸烟、主动吸烟的CKD患病率分别为29.9％ （40/134）、35.9％ （66/184）、7/13.被动吸烟和主动吸烟的T2DM患者与不吸烟患者相比,发生CKD的风险均有所增加,分别为男性OR=1.07以及OR=1.05;女性OR=1.31以及OR=2.74.（2）被动吸烟的女性T2DM患者发生蛋白尿风险较不吸烟者显著升高（OR =2.02,95％ CI1.133～3.601,P=0.016）.（3）校正性别、年龄、病程、BMI、收缩压、血脂、糖化血红蛋白等变量后,男性患者不同吸烟状态的估算的GFR结果差异无统计学意义;主动吸烟的女性T2DM患者与不吸烟及被动吸烟患者估算的GFR差异均有统计学意义（P =0.018和P=0.000）.结论 被动吸烟和主动吸烟的T2DM患者发生CKD的风险较不吸烟患者增加.因此对T2DM患者应加强戒烟教育和建议,同时避免暴露于被动吸烟的环境.

Objective This study aimed to assess the effects of active and passive smoking on chronic kidney disease （CKD） in patients with type 2 diabetes mellitus （T2DM）.Methods Seven hundred and five patients with T2DM were recruited in the study and were divided into three groups based on smoking status as active smokers,passive smokers and non-smokers.Twenty-four hour urinary albumin excretion （24hUAE） was measured,and estimate glomerular filtration rate （eGFR） was calculated with age and blood creatinine levels.Results （1） The proportion of CKD in T2DM in the present study was 31.63% （223/705） with 28.6% （22/77）,30.0% （15/50） and 29.6% （73/247） for non-smokers,passive smokers and active smokers in men,and 29.9% （40/134）,35.9% （66/184） and 7/13 for non-smokers,passive smokers and active smokers in women,respectively.In comparison with non-smokers,a higher risk of CKD was found in both passive and active smokers （OR =1.07 and OR =1.05 in men ; OR =1.31 and OR =2.74 in women,respectively）.（2） Compared with non-smokers,passive smokers had a significant higher risk for albuminuria in women （OR =2.02,P =0.016）.（3） After adjusting for gender,age,duration of T2DM,BMI,systolic blood pressure,glycosylated hemoglobin A1C and lipids,there was a significant decrease in eGFR between active and never smokers （P =0.018）or passive smokers （P =0.000） in women.No differences could be found in eGFR between each smoking statues in men.Conclusions Smoking exposure alone confers a high risk for CKD in patients with T2DM.Our results highlight an importance in implementation of a smoke-free environment for patients with T2DM.