Cazzato Salvatore, Bernardi Filippo, Salardi Silvana, Tassinari Davide, Corsini Ilaria, Ragni Luca, Cicognani Alessandro, Cacciari Emanuele
Department of Pediatrics, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
Pediatr Pulmonol. 2004 Jan;37(1):17-23. doi: 10.1002/ppul.10399.
A cross-sectional study design was undertaken to assess pulmonary function in children with insulin-dependent diabetes mellitus (IDDM), and to establish if there is any relationship with diabetic factors and complications. Thirty-eight children (10 +/- 1.8 years) with IDDM and without clinical or radiological evidence of lung involvement, and 41 healthy age-matched reference subjects, underwent a pulmonary function study. Thirteen (34%) of 38 subjects with IDDM were studied at the onset of their disease. Adjusted values expressed as SD score of forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV(1)), and the transfer factor for carbon monoxide (TLCO) were found to be significantly lower than in controls (-0.54 +/- 0.87 vs. 0.40 +/- 1.10, P = 0.0008; -0.11 +/- 0.96 vs. 0.52 +/- 1.07, P = 0.01; -1.60 +/- 1.07 vs. -0.57 +/- 1.28, P = 0.001, respectively). These differences also existed in the group investigated at onset of diabetes. Residual volume (RV) and RV/total lung capacity ratio (RV/TLC) were significantly higher in the whole group of patients with IDDM than in controls (-0.20 +/- 0.83 vs. -0.80 +/- 0.88, P = 0.003; and 26 +/- 6.2 vs. 21 +/- 5.0, P = 0.0002, respectively). Seventeen patients (45%) had abnormal pulmonary function (SD score, less than -1.64): 16 subjects had reduced TLCO, 4 had reduced FVC, and in 3 of the 17, both functional indices were abnormal. There was no significant relationship between pulmonary function indices and diabetic factors or complications. The only significant association was between abnormal TLCO and females (P = 0.03), suggesting that sex may be a predisposing factor for the development of pulmonary complications. This study supports the view that the lung is functionally involved in children with IDDM early on in the course of the disease.
采用横断面研究设计来评估胰岛素依赖型糖尿病（IDDM）患儿的肺功能，并确定其与糖尿病因素及并发症之间是否存在关联。38名IDDM患儿（年龄10±1.8岁），无肺部受累的临床或影像学证据，以及41名年龄匹配的健康对照者接受了肺功能研究。38名IDDM患儿中有13名（34%）在疾病发作时接受了研究。以用力肺活量（FVC）、第1秒用力呼气量（FEV₁）和一氧化碳弥散量（TLCO）的标准差得分表示的校正值显著低于对照组（分别为-0.54±0.87对0.40±1.10，P = 0.0008；-0.11±0.96对0.52±1.07，P = 0.01；-1.60±1.07对-0.57±1.28，P = 0.001）。这些差异在糖尿病发作时接受研究的组中也存在。IDDM患儿全组的残气量（RV）和RV/肺总量比值（RV/TLC）显著高于对照组（分别为-0.20±0.83对-0.80±0.88，P = 0.003；以及26±6.2对21±5.0，P = 0.0002）。17名患者（45%）肺功能异常（标准差得分小于-1.64）：16名受试者TLCO降低，4名FVC降低，17名中有3名两项功能指标均异常。肺功能指标与糖尿病因素或并发症之间无显著关联。唯一显著的关联是异常TLCO与女性之间（P = 0.03），这表明性别可能是肺部并发症发生的一个易感因素。本研究支持这样的观点，即肺部在IDDM患儿疾病进程早期就存在功能受累。
