糖脂代谢异常对肺源性心脏病患者肺功能影响的单中心回顾性分析

Single center retrospective analysis of the effect of abnormal glucose and lipid metabolism on pulmonary function in patients with pulmonary heart disease

目的分析糖脂代谢异常对肺源性心脏病(CPHD)患者肺功能影响。方法选择2019年1月至2021年1月于我院收治的CPHD患者162例,患者根据是否存在糖脂代谢异常情况分为对照组(糖脂代谢正常)95例及观察组(糖脂代谢异常)67例。采集2组患者年龄、性别、体质指数(BMI)、吸烟史等一般资料,比较2组患者糖脂代谢指标[空腹血糖(FPG)、餐后2 h血糖(2 hPG)、总胆固醇(TC)、甘油三酯(TG)],采用双源CT机检查,比较2组患者肺活量占预计值的百分比(VC%pred)、用力肺活量占预计值的百分比(FVC%pred)、第一秒用力呼气容积(FEV1)占预计值的百分比(FEV1%pred)、最高呼气流量(PEF)占预计值的百分比(PEF%pred)等肺功能指标。比较2组患者慢性阻塞性肺疾病全球倡议(GOLD)的肺功能分级。采用Spearman相关系数分析糖脂代谢异常、空腹血糖、糖化白蛋白水平与肺功能相关指标的相关性,采用多因素Logistic回归分析糖脂代谢异常肺心病患者肺功能的相关影响因素。结果2组患者年龄、性别、BMI及吸烟史等一般资料差异均无统计学意义(P>0.05)。观察组患者FPG、2 h PG、TC、TG水平明显高于对照组,差异有统计学意义(P<0.05)。观察组患者VC%pred、FVC%pred、FEV1%pred、PEF%pred水平明显低于对照组,3~4级GOLD分级比例明显高于对照组(P<0.05)。Spearman相关系数分析发现,糖脂代谢异常、空腹血糖、糖化白蛋白与VC%pred、FVC%pred、FEV1%pred、PEF%pred水平呈明显负相关,与GOLD分级呈明显正相关(P<0.05)。Logistic多因素回归分析显示,糖脂代谢异常、空腹血糖、糖化白蛋白均是糖脂代谢异常CPHD患者肺功能降低的独立危险因素(P<0.05)。结论糖脂代谢异常在CPHD患者中具有较高的发病率,糖脂代谢相关指标与CPHD患者的肺功能呈明显相关性,是影响CPHD患者肺功能降低的独立危险因素。

Objective To analyze the effect of abnormal glucose and lipid metabolism on pulmonary function in patients with pulmonary heart disease(CPHD).Methods One hundred and sixty-two patients with CPHD in our hospital from January 2019 to January 2021 were selected and divided into control group(normal glucose metabolism,n=95)and observation group(abnormal glycolipid regulation,n=67)according to the presence of abnormal glucose metabolism.The age,sex,body mass index(BMI),smoking history and other general data of the two groups were collected,compare fasting blood glucose(FPG),2 h postprandial glucose(2 h PG)total cholesterol(TC)and Triglycerids(TG)in two groups and the dual-source CT machine was used for CT examination.The lung function indexes such as the percentage of vital capacity in the predicted value(VC%pred),the percentage of forced vital capacity in the predicted value(FVC%pred),the percentage of forced expiratory volume in the first second(FEV1%pred)and the percentage of maximum expiratory flow(PEF%pred)in the predicted value were compared between the two groups.The pulmonary function grades of the global initiative for chronic obstructive pulmonary disease(GOLD)were compared between the two groups.The Spearman correlation coefficient was used to analyze the correlation between abnormal glucose metabolism,FPG,glycosylated albumin and related indexes of pulmonary function.Multivariate logistic regression was used to analyze the related factors of pulmonary function in patients with abnormal glucose metabolism and CPHD.Results General data such as age,gender,BMI and smoking history between the two groups had no significant diffrences(P>0.05).The levels of FPG,2 h PG,TC and TG in the observation group were significantly higher than those in the control group(P<0.05).The levels of VC%perd,FVC%pred,FEV1%pred and PEF%pred in the observation group were significantly lower than those in the control group,and the proportions of grade 3~4 and GOLD were significantly higher than those in the control group(P<0.05).Spearman correlation coefficient analysis showed that abnormal glucose metabolism,FBG and glycosylated albumin were significantly negatively correlated with the levels of VC%pred,FVC%pred,FEV1%pred and PEF%pred,and positively correlated with GOLD grade(P<0.05).Logistic multivariate regression analysis showed that abnormal glucose metabolism,FBG and glycosylated albumin were independent risk factors for the decrease of pulmonary function in patients with abnormal glucose metabolism cor pulmonale(P<0.05).Conclusion Abnormal glucose metabolism has high incidence rate in CPHD patients,and glycometabolism-related indexes are significantly correlated with lung function in CPHD patients and are independent risk factors for lung function decline in CPHD patients.