吸烟对男性2型糖尿病患者下肢经皮氧分压的影响

Effect of smoking on transcutaneous oxygen pressure of lower extremity in male patients with type 2 diabetes

目的评估吸烟对男性2型糖尿病(T2DM)患者下肢经皮氧分压(TcPO2)的影响,探讨戒烟是否有助于其TcPO2的改善。方法选取2014年8月至2017年10月在东南大学附属中大医院内分泌科住院的男性T2DM患者120例,根据吸烟史分为吸烟(CS)组、戒烟(QS)组及不吸烟(NS)组,每组均40例。分别测定和比较静息平卧状态与5 min平板运动后各研究对象的足背及胸部TcPO2。基线资料的比较采用方差分析,运动前后各参数的比较采用重复测量资料的广义估计方程分析。结果(1)静息平卧状态:CS组足背TcPO2(36.12±10.25)mmHg(1 mmHg=0.133 kPa),较NS组(55.46±7.32)mmHg和QS组(41.05±11.23)mmHg明显下降(F=1.145、2.221,均P<0.05),QS组与NS组间TcPO2差异无统计学意义(F=1.258,P>0.05);CS组、QS组及NS组双侧灌注指数(BPI)分别为0.78±0.16、0.81±0.17、0.89±0.13,差异均无统计学意义(F=1.125,P>0.05)。(2)5 min平板运动后20 min内,3组的胸部TcPO2均呈升高趋势,组间差异无统计学意义(Wald χ^2=3.212,P>0.05);与NS组的足背TcPO2(B=0)比较,CS组(B=-46.823)及QS组(B=-38.267)均显著降低(Wald χ^2=8.263、6.078,均P<0.05),而CS组与QS组间差异无统计学意义(Wald χ^2=0.512,P>0.05)。结论吸烟可导致男性T2DM患者下肢TcPO2明显下降;戒烟在一定程度上可以缓解此损害,但并不能完全消除。

Objective To evaluate the effect of smoking and smoking cessation on transcutaneous oxygen pressure (TcPO2) of low extremity in man with type 2 diabetics. Methods 120 men with type 2 diabetes (aged≥18 years) were recruited from the Endocrinology Department, Zhongda Hospital, Southeast University. Based on the smoking status, they were assigned to three groups: current-smoking (CS, n=40);quit-smoking (QS, n=40) and non-smoking (NS, n=40). General clinical data of all subjects were recorded and assessed. TcPO2 at the dorsum of foot and chest was monitored before and after five-minute treadmill exercise. Analysis of variance (ANOVA) and Generalized Estimating Equations (GEE) were performed to analyze the effect of smoking/smoking-cessation on TcPO2 before and after exercise respectively. Results In resting-state (t=0 min), the TcPO2 on dorsal foot in CS was significantly decreased compared with NS ((36.12±10.25) vs (55.46±7.32) mmHg, 1 mmHg=0.133 kPa, F=1.145, P=0.011) and QS (41.05±11.23, F=2.221, P=0.023). Instead, TcPO2 on the chest and bilateral perfusion index were undifferentiated among the three groups (F=1.125, P=0.424). After a five-minute treadmill exercise, TcPO2 on the chest showed an upward trend in all three groups with no significant difference (Wald χ^2=3.212, P=0.549). The partial regression coefficient B of TcPO2 at dorsum of foot decreased significantly in CS (B=-46.823) and QS (B=-38.267) and the difference was statistically significant compared with NS (Wald χ^2=8.263, 6.078 and all P<0.05) in spite of no difference between the CS and QS (Wald χ^2=0.512, P>0.05). Conclusions Smoking can induce a decline in TcPO2 in man with type 2 diabetics. To an extent, smoking cessation only ameliorates the decrease of TcPO2 in the lower extremities.