2型糖尿病患者肺功能损害及其相关影响因素分析

Analysis of Pulmonary Function Damage Related Factors in Patients with Type 2 Diabetes

目的:探讨2型糖尿病患者肺功能变化及其相关的影响因素。方法:分别选取我院近2年来2型糖尿病患者(观察组)和非糖尿病患者(对照组)各90例,检测肺功能、胆固醇、三酰甘油、脂蛋白a、血同型半胱氨酸、空腹血糖、糖化血红蛋白(Hb A1C)、血气分析等指标,对两组上述指标进行对比分析,对糖尿病组肺功能改变的有关因素进行多元线性回归分析。结果:观察组肺活量(VC)、1秒用力呼气容积(FEV1)、最大自主通气量(MVV)、肺总量(TLC)与DLCO、DLCO/VA、Pa02和Sa02与对照组相比显著降低(P<0.05);观察组中,肺通气功能相关指标VC、FEV1/FVC、FEV1及肺弥散功能相关指标DLCO、DLCO/VA与Hb A1c呈显著负相关(P<0.05)。随着Hb A1c的上升,T2DM患者的肺功能各指标均明显降低,Hb A1c>8.5%的T2DM患者肺功能各指标(DLCO、DLCO/VA、VC及FEV1)均显著降低(P<0.05);观察组微血管并发症与DLCO、DLCO/VA呈负相关(P<0.05)。其中,微血管并发症积分达2分或以上者比无并发症者的DLCO和DLCO/VA有明显降低(P<0.05);观察组中胰岛素抵抗越明显,DLCO降低的就越显著(P<0.05),而对照组中无胰岛素抵抗。观察组同型半胱氨酸的水平越高,VC下降的就越显著(P<0.05)。结论:T2DM患者存在通气功能下降(以限制性为主)和弥散功能障碍,血糖水平、胰岛素抵抗指数、微血管并发症积分、同型半胱氨酸浓度等可能是影响肺功能下降的重要原因。

Objective To investigate the changes of pulmonary function related influencing factors in patients with type 2 diabetes.Methods Ninety patients with type 2 diabetes mellitus(observation group)and 90 patients with non-diabetes mellitus(control group)in our hospital in the past two years were selected to detect lung function,cholesterol,triglyceride,lipoprotein A,homocysteine,fasting blood glucose,glycosylated hemoglobin(Hb A1 C),blood gas analysis and other indicators.The above indicators were compared and analyzed.The lung function-related variable factors in diabetic group were analyzed by multiple linear regression.Results The vital capacity(VC),forced expiratory volume(FEV1),maximal spontaneous ventilation(MVV)and total lung volume(TLC),DLCO,DLCO/VA,PaO2 and Sa O2 in the experimental group were significantly lower than those in the control group(P<0.05).In the experimental group,VC,FEV1/FVC,FEV1 and DLCO,DLCO/VA were negatively correlated with Hb A1 c(P<0.05).The lung function(DLCO,DLCO/VA,VC and FEV1)of T2 DM patients with Hb A1 c>8.5%were significantly decreased(P<0.05).There was a negative correlation between microvascular complications and DLCO,DLCO/VA in experimental group(P<0.05).The DLCO and DLCO/VA of the patients with microvascular complication score of 2 or more were significantly lower than that of the patients without complications(P<0.05).The more obvious the insulin resistance in the experimental group,the more significant the decrease of DLCO(P<0.05).The higher the homocysteine level in the experimental group,the more significant the decrease of VC(P<0.05).Conclusion The decrease of ventilation function(mainly restricted),diffusion dysfunction,blood glucose level,insulin resistance index,microvascular complication score and homocysteine concentration in T2 DM patients may be the important factors influencing the decline of pulmonary function.