2型糖尿病患者的肺功能损害及其相关因素分析

目的研究T2DM患者的肺功能损害及其影响因素。方法选取我院100例诊断为T2DM的患者及40名健康志愿者，检测肺功能及动脉血气进行对照研究，并以肺功能各项指标与FPG、胰岛素敏感性指数（ISI）、HbA1c、BMI和糖尿病病程等进行多因素线性回归分析。结果（1）T2DM组BMI明显高于对照组（P〈0．01）。（2）T2DM组肺总量（TLC）、用力肺活量（FVC）、1秒用力呼气量（FEV1）、用力呼出气量为50％肺活量的最大呼气中期流量（MMEF50）、用力呼出气量为25％肺活量的最大呼气中期流量（MMEF25）明显低于对照组（P〈0．01）。T2DM组一氧化碳弥散量（DLCO）、弥散指数（DLCO／VA）、动脉血氧分压（PaO2）和血氧饱和度（SaO2）低于对照组（P〈0．01）。（3）TLC、FVC、FEV1、MMEF50与FPG、2hPG、FC-P、2hC-P、HbA1c、BMI、ISI、病程无明显相关；但DL（如、DLCO／VA、MMEF25与FPG、2hPG、FC-P、2hC-P、HbA1c、BMI、病程呈显著负相关（P〈0．05或P〈0．01），与ISI呈显著正相关（P〈0．05）。结论（1）T2DM患者肺功能损害主要表现为限制性通气功能障碍、小气道功能减退和弥散功能异常。（2）FPG、2hPG、FC-P、2hC-P、HbA1c、BMI、病程、ISI与T2DM小气道损害和肺弥散功能障碍密切相关。

Analysis of the lung function damage and its related factors in patients with type 2 diabetes mellitus

Objective To explore the lung function damage and its related factors in patients with type 2 diabetes. Methods From January 2007 to December 2007, 100 eases of hospitalized type 2 diabetes （T2DM） patients and 40 healthy volunteers were randomly selected from General Hospital ＇of Daqing Oil Field. The parameters of lung function and arterial blood gas were compared between normal subjects and patients with type 2 diabetes. The correlations of indexes of pulmonary function with changes of FPG, ISI, HbA1 c, BMI and diabetic duration were analyzed with multiple linear regression. Results （1）BMI was higher in T2DM group than in control group （P〈0. 01）. （2） The T2DM group versus the control group showed the decreased levels of TLC, FVC, FEV1, MMEF50, MMEF25, DLCO, DLCO/VA, PaO2 and SaO2 （all P〈0. 01）. （3） TLC, FVC, FEV1, MMEFs0 had no significant correlation with FPG, 2hPG,FCP, 2hCP, HbAlc, BMI, ISI, diabetic duration （P〈0. 05） in T2DM group. However, DLCO, DLCO/VA , MMEF25 were negatively correlated with FPG, 2hPG, FCP, 2hCP, HbA1c, BMI, and diabetic duration （P〈0. 05 or P〈0. 01 ）. MMEF25 ,DLCO and DLCO/VA were positively correlated with the ISI （P〈0. 05）. Conclusion （1） Lung function damage in patients with type 2 diabetes mainly presents as restrictive ventilatory functional disturbance, small airway dysfunction and abnormal diffusing capacity. （2）FPG, 2hPG, FCP, 2hCP, HbA1c, BMI, diabetic duration, and ISI are closely related with small airway dysfunction and abnormalities of diffusive function in type 2 diabetes group.