Anan F, Takahashi N, Shinohara T, Nakagawa M, Masaki T, Katsuragi I, Tanaka K, Kakuma T, Yonemochi H, Eshima N, Saikawa T, Yoshimatsu H
Department of Cardiovascular Science, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Oita 879-5593, Japan.
Eur J Clin Invest. 2006 Jul;36(7):459-65. doi: 10.1111/j.1365-2362.2006.01650.x.
Smoking and cardiovascular autonomic dysfunction are associated with high mortality in type 2 diabetic patients. This study tested the hypothesis that smoking is associated with insulin resistance/hyperinsulinaemia and cardiovascular autonomic dysfunction in type 2 diabetic patients who are not treated with insulin.
The study patients were 22 current smokers with type 2 diabetes mellitus (age: 57 +/- 5 years, mean +/- SD) and 30 age-matched never-smoked patients with type 2 diabetes mellitus (control group, 57 +/- 8 years). The quality of blood glucose was assessed by fasting plasma glucose (FPG), fasting immunoreactive insulin (F-IRI), homeostasis model assessment (HOMA) index and haemoglobin A1c (HbA1c). The severity of smoking status was expressed by the Brinkman index, which is calculated as number of cigarettes per day multiplied by years of smoking. Cardiovascular autonomic function was assessed by baroreflex sensitivity (BRS), heart-rate variability, plasma norepinephrine concentration and cardiac (123)I-metaiodobenzylguanidine (MIBG) scintigraphic findings.
Baroreflex sensitivity was lower in the current smokers group than in the never-smoked group (P < 0.05). Early and delayed (123)I-MIBG myocardial uptake values were lower (P < 0.05, and P < 0.01, respectively) and the percentage washout-rate of (123)I-MIBG was higher (P < 0.0001) in the current smokers group than in the never-smoked group. Fasting immunoreactive insulin (F-IRI) concentration (P < 0.0001) and the homeostasis model assessment (HOMA) index (P < 0.0001) were higher in the current smokers group than the never-smoked group. Multiple logistic regression analysis revealed that smoking was independently predicted by F-IRI and the percentage washout-rate of (123)I-MIBG.
The results of the study suggested that smoking was associated with cardiovascular autonomic dysfunction and hyperinsulinaemia and that F-IRI and the percentage washout-rate of (123)I-MIBG were independent predictors of smoking in these Japanese patients with type 2 diabetes mellitus.
吸烟与2型糖尿病患者的高死亡率相关。本研究检验了这样一个假设：在未接受胰岛素治疗的2型糖尿病患者中，吸烟与胰岛素抵抗/高胰岛素血症及心血管自主神经功能障碍有关。
研究对象为22名2型糖尿病现吸烟者（年龄：57±5岁，均值±标准差）和30名年龄匹配的2型糖尿病既往不吸烟者（对照组，57±8岁）。通过空腹血糖（FPG）、空腹免疫反应性胰岛素（F-IRI）、稳态模型评估（HOMA）指数和糖化血红蛋白（HbA1c）评估血糖质量。吸烟状况的严重程度用布林克曼指数表示，该指数通过每日吸烟支数乘以吸烟年限计算得出。通过压力反射敏感性（BRS）、心率变异性、血浆去甲肾上腺素浓度和心脏（123）I-间碘苄胍（MIBG）闪烁显像结果评估心血管自主神经功能。
现吸烟者组的压力反射敏感性低于既往不吸烟者组（P<0.05）。现吸烟者组的早期和延迟（123）I-MIBG心肌摄取值较低（分别为P<0.05和P<0.01），且（123）I-MIBG的清除率百分比更高（P<0.0001）。现吸烟者组的空腹免疫反应性胰岛素（F-IRI）浓度（P<0.0001）和稳态模型评估（HOMA）指数（P<0.0001）高于既往不吸烟者组。多因素逻辑回归分析显示，F-IRI和（123）I-MIBG的清除率百分比可独立预测吸烟情况。
研究结果表明，吸烟与心血管自主神经功能障碍和高胰岛素血症有关，且F-IRI和（123）I-MIBG的清除率百分比是这些日本2型糖尿病患者吸烟情况的独立预测因素。
