Villa M P, Montesano M, Barreto M, Pagani J, Stegagno M, Multari G, Ronchetti R
Department of Paediatrics, Sant'Andrea Hospital, II Faculty of Medicine, University La Sapienza, Via di Grottarossa, 1035-1039, 00189 Rome, Italy.
Diabetologia. 2004 Nov;47(11):1931-5. doi: 10.1007/s00125-004-1548-7. Epub 2004 Nov 24.
AIMS/HYPOTHESIS: Few data are available on lung dysfunction in children with diabetes. We studied the association of pulmonary function variables (flows, volumes and alveolar capillary diffusion) with disease-related variables in children with type 1 diabetes mellitus.
We studied 39 children with type 1 diabetes (mean age 10.9+/-2.6 years, disease duration 3.6+/-2.4 years, insulin.kg(-1).day(-1) 0.77+/-0.31) and 30 healthy control children (mean age 10.4+/-3.0 years). Pulmonary function tests included spirometry, N(2) wash-out and the single-breath diffusing capacity for carbon monoxide (DL(CO)) corrected for the alveolar volume (DL(CO)/V(A)). Glycaemic control was assessed on the basis of HbA(1)c, with HbA(1)c values of 8% or less considered to indicate good glycaemic control, and HbA(1)c values of 8% or more considered to indicate poor control.
Children with poor glycaemic control had comparable percentage values for predicted flows and volumes but lower DL(CO)/V(A) values than children with good glycaemic control and healthy control children (86.7+/-12.6 vs 99.8+/-18.4 and 102.0+/-15.7; p<0.05). The predicted DL(CO)/V(A) percentages correlated with HbA(1)c levels (r=-0.39, p=0.013). A multiple regression analysis (stepwise model) controlling for HbA(1)c levels and other disease-related variables (age of disease onset, disease duration, daily insulin dose/kg, sex) identified HbA(1)c levels as the sole predictor of DL(CO)/V(A) in percent.
CONCLUSIONS/INTERPRETATION: In children with type 1 diabetes, the diffusing capacity diminishes early in childhood and is associated with poor metabolic control. Although low DL(CO)/V(A) levels in these children probably reflect pulmonary microangiopathy induced by type 1 diabetes, other factors presumably influencing CO diffusion capacity measurements (e.g. a left shift in HbA(1)c resulting in high O(2) binding and low CO binding) could explain the apparent capillary and alveolar basal membrane dysfunction.
目的/假设：关于糖尿病患儿肺功能障碍的数据较少。我们研究了1型糖尿病患儿的肺功能变量（流量、容积和肺泡毛细血管弥散）与疾病相关变量之间的关联。
我们研究了39例1型糖尿病患儿（平均年龄10.9±2.6岁，病程3.6±2.4年，胰岛素用量0.77±0.31U·kg⁻¹·d⁻¹）和30例健康对照儿童（平均年龄10.4±3.0岁）。肺功能测试包括肺活量测定、氮洗脱和根据肺泡容积校正的单次呼吸一氧化碳弥散量（DL(CO)/V(A)）。根据糖化血红蛋白（HbA(1)c）评估血糖控制情况，HbA(1)c值≤8%被认为血糖控制良好，HbA(1)c值＞8%被认为血糖控制不佳。
血糖控制不佳的患儿预测流量和容积的百分比值与血糖控制良好的患儿及健康对照儿童相当，但DL(CO)/V(A)值低于他们（86.7±12.6 vs 99.8±18.4和102.0±15.7；p<0.05）。预测的DL(CO)/V(A)百分比与HbA(1)c水平相关（r=-0.39，p=0.013）。一项控制HbA(1)c水平和其他疾病相关变量（发病年龄、病程、每日胰岛素剂量/kg、性别）的多元回归分析（逐步模型）确定HbA(1)c水平是DL(CO)/V(A)百分比的唯一预测因素。
结论/解读：在1型糖尿病患儿中，弥散能力在儿童早期就会降低，且与代谢控制不佳有关。尽管这些患儿较低的DL(CO)/V(A)水平可能反映了1型糖尿病所致的肺微血管病变，但其他可能影响一氧化碳弥散能力测量的因素（如HbA(1)c左移导致氧结合增加和一氧化碳结合减少）也可能解释明显的毛细血管和肺泡基底膜功能障碍。
