2型糖尿病患者肺功能变化与胰岛素水平的关系初探

The relationship between the pulmonary function with insulin level in type-2 diabetes mellitus patients.

目的探讨 2型糖尿病患者的肺功能变化及其与胰岛素抵抗和胰岛 β细胞分泌功能的关系。方法测定 60例 2型糖尿病患者 (糖尿病组 )和 3 5例健康对照组肺功能 ,并进行比较分析。对糖尿病组进行胰岛素释放试验 ( IRT) ,计算胰岛素敏感指数 ( ISI)和胰岛 β细胞分泌指数 ( MBCI) ,并对相关因素进行分析。结果糖尿病组的总肺活量 ,用力肺活量 ,肺活量 1秒量 ,70 %～ 80 %肺活量阶段内平均呼气流量 ( V 2 5 ) ,肺一氧化碳弥散量 ( DL CO)均明显低于对照组 ( P<0 .0 5或 P<0 .0 1)。多元线性分析表明 ,V 2 5、DLCO与空腹血糖( FPG)、空腹胰岛素 ( FINS)及微血管并发症积分呈负相关 ( P<0 .0 5 ) ,与 ISI呈正相关 ( P<0 .0 5 ) ,而与 MBCI无关。结论 2型糖尿病患者存在以限制性为主的肺通气功能障碍和小气道阻塞以及弥散功能障碍。 FPG、FINS、胰岛素抵抗及微血管病变程度等可能是影响肺功能的主要因素 ,而与胰岛β细胞分泌功能无关。

objective To explore the changes of pulmonary function and its relationship with insulin resistance and the secretion of insulin β cell in the patients with type 2 diabetes mellitus(T2DM).Methods The pulmonary function of 60 patients with T2DM and 35 healthy subjects was measured and analyzed.To the patients in T2DM group,insulin releasing test(IRT) was done to count insulin sensitive index(ISI) and β cell secretion index(MBCI).Meanwhile,the related factors were analyzed.Results The total lung capacity(TLC),forced vital capacity (FVC),1 second forced expiratory volume (FEV1.0),average expiratory volume of 70%-80% lung capacity(V25),and diffuse volume of CO(DVCO) in T2DM group were significantly lower than those in control group(P<0.05 or P<0.01).Multivariabels linear analysis showed that V25 and DVCO were negatively correlated with fasting plasma glucose (FPG),fasting insulin (FINS) and score of microvessel complications(P<0.05) and were positively correlated with ISI (P<0.05) but were not correlated with MBCI.Conclusion Type 2 diabetes patients have restricted pulmonary ventilation disorder,obstruction of the small respiratory tracts and diffusive dysfunction.FPG,FINS IR and microvessel lesion degree may be the primary factors to affect the pulmonary function but pancreatic β cell secretion has no effect.