老年支气管哮喘合并2型糖尿病患者临床特征分析

Analysis of clinical characteristics of elderly patients with bronchial asthma complicated with type 2 diabetes

目的探讨老年支气管哮喘合并2型糖尿病患者的临床及炎症特征。方法2022年6月1日—2023年5月31日在管辖社区内针对支气管哮喘非急性发作期的患者在老年人群中进行支气管哮喘问卷调查,将筛选出的52例老年支气管哮喘合并2型糖尿病患者作为观察组,同时设立3个对照组:单纯2型糖尿病组(糖尿病组)、单纯哮喘组(哮喘组)、及体检健康对照组(健康组),每组52例。比较4组空腹血糖值、除健康组外比较其余3组哮喘控制测试评分(ACT),比较4组第一秒用力肺活量占预计值的百分比(FEV1 pred%)、呼气峰流速占预计值的百分比(PEF pred%)、呼出气一氧化氮(FeNO)值;比较4组外周血清IgE抗体、白介素-4(IL-4)、白介素-17(IL-17)、丙二醛(MDA)及超氧化物歧化酶(SOD)水平。结果观察组空腹血糖水平均高于3个对照组,糖尿病组高于哮喘组、健康组,差异均有统计学意义(P<0.05);观察组ACT评分、FEV1 pred%及PEF pred%值均低于3个对照组,哮喘组低于糖尿病组、健康组,差异均有统计学意义(P<0.05);观察组和哮喘组外周血清IL-17水平高于糖尿病组、健康组,差异均有统计学意义(P<0.01);糖尿病组IL-17水平高于健康组(P<0.05)。观察组、哮喘组及糖尿病组外周血清MDA水平均高于健康组、而SOD水平低于健康组,差异均有统计学意义(P<0.01、P<0.05);且观察组MDA水平高于哮喘组、糖尿病组,SOD水平低于哮喘组、糖尿病组,差异均有统计学意义(P<0.05)。结论支气管哮喘合并2型糖尿病临床症状重,哮喘控制水平低,肺通气功能下降明显,机制上倾向于非嗜酸性炎症,氧化应激起重要作用。

Objective To investigate the clinical and inflammatory characteristics of elderly patients with bronchial asthma complicated with type 2 diabetes.Methods A bronchial asthma questionnaire was conducted in the elderly population from June 1,2022 to May 31,2023 in a community for patients with non-acute episodes of bronchial asthma.52 elderly patients with bronchial asthma complicated with type 2 diabetes were selected as the observation group.At the same time,three control groups were set up:simple type 2 diabetes group(diabetes group),simple asthma group(asthma group),and physical examination health control group(health group),with 52 cases in each group.Asthma control test(ACT)score were compared among the other 3 groups except health group;the fasting blood glucose(FBG),the percentage of forced vital capacity in the first second to the expected value(FEV1pred%),the percentage of peak expiratory flow rate to the expected value(PEFpred%),and exhaled nitric oxide(FeNO)were compared among the 4 groups;the levels of serum IgE antibody(IgE),interleukin-4(IL-4),interleukin-17(IL-17),malondialdehyde(MDA)and superoxide dismutase(SOD)were compared among the 4 groups.Results The FBG level of the observation group was higher than that of other three control groups,the FBG level of the diabetes group was higher than those of the asthma group and the healthy group,and the differences were statistically significant(P<0.05).The ACT score,FEV1pred%and PEFpred%of the observation group were lower than those of other three control groups,the ACT score,FEV1pred%and PEFpred%of the asthma group were lower than those of the diabetes group and the healthy group,and the differences were statistically significant(P<0.05).The serum IL-17 level of the observation group and the asthma group was higher than that of the diabetes group and healthy group,and the differences were statistically significant(P<0.01);the serum IL-17 level of the diabetic group was higher than that of the healthy group,and the difference was statistically significant(P<0.05).The serum MDA level of the observation group,asthma group and diabetes group was higher than that of the healthy group,and the serum SOD level was lower than that of the healthy group,and the differences were statistically significant(P<0.01,P<0.05);the serum MDA level of the observation group was higher than that of the asthma group and diabetes group,the serum SOD level was lower than that of the asthma group and diabetes group,and the differences were statistically significant(P<0.05).Conclusion Patients with bronchial asthma complicated with type 2 diabetes have severe clinical symptoms,low level of asthma control,and significant decrease in pulmonary ventilation function.Its mechanism tends to be non-eosinophilic inflammation,and oxidation stress may play an important role.