CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Diabetes and Metabolism Research Unit, Institut de Recerca Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron, 119-129, 08035 Barcelona, Spain,
Diabetologia. 2010 Jun;53(6):1210-6. doi: 10.1007/s00125-010-1700-5. Epub 2010 Mar 9.
AIMS/HYPOTHESIS: To determine whether the presence of type 2 diabetes and the degree of metabolic control are related to reduced pulmonary function in obese individuals.
Seventy-five morbidly obese women (25 with type 2 diabetes [cases]--and 50 without diabetes [controls]) with a history of non-smoking and without prior cardiovascular or respiratory disease were prospective recruited for a case-control study in the outpatient obesity unit of a referral centre. Both groups were closely matched by age, BMI and waist circumference. Pulmonary function test included forced spirometry and static pulmonary volume measurements.
Type 2 diabetic patients showed lower forced expiratory volume at 1 s (FEV1) (mean difference -11.6% of predicted [95% CI -20.4 to -2.8]; p = 0.011), and FEV1/forced vital capacity (FEV1/FVC) ratio (mean difference -4.4% [95% CI -8.1 to -0.7]; p = 0.049), but a greater residual volume (RV) (mean difference 19.5% of predicted [95% CI 10.8-28.3]; p < 0.001). In addition, an obstructive ventilatory pattern was more frequent in diabetic patients. Significant negative correlations between FEV1 and fasting glucose, HbA1c and HOMA insulin resistance (HOMA-IR) were detected. By contrast, RV was positively correlated with fasting glucose, HbA1c and HOMA-IR. Multiple linear regression analyses showed that fasting glucose and HbA1c independently predicted FEV1 and RV.
CONCLUSIONS/INTERPRETATION: The presence of diabetes and the degree of glycaemic control are related to respiratory function impairment in morbidly obese women. Therefore, the impact of type 2 diabetes on pulmonary function should be taken into consideration by those providing care for obese people.
目的/假设：确定 2 型糖尿病的存在及其代谢控制程度与肥胖个体的肺功能下降是否相关。
在一家转诊中心的门诊肥胖科，前瞻性地招募了 75 名患有 2 型糖尿病（病例组，25 例）和 50 名无糖尿病（对照组）的病态肥胖女性（既往无吸烟史，无先前的心血管或呼吸系统疾病）。这两组在年龄、BMI 和腰围方面均匹配良好。肺功能测试包括用力肺活量测定和静态肺容积测量。
2 型糖尿病患者的 1 秒用力呼气量（FEV1）（预测值的平均差异-11.6%[95%置信区间-20.4 至-2.8]；p=0.011）和 FEV1/用力肺活量（FEV1/FVC）比值（预测值的平均差异-4.4%[95%置信区间-8.1 至-0.7]；p=0.049）均较低，但残气量（RV）较大（预测值的平均差异 19.5%[95%置信区间 10.8-28.3]；p<0.001）。此外，糖尿病患者更常出现阻塞性通气模式。FEV1 与空腹血糖、HbA1c 和 HOMA 胰岛素抵抗（HOMA-IR）呈显著负相关。相反，RV 与空腹血糖、HbA1c 和 HOMA-IR 呈正相关。多元线性回归分析显示，空腹血糖和 HbA1c 独立预测 FEV1 和 RV。
结论/解释：糖尿病的存在及其血糖控制程度与病态肥胖女性的呼吸功能受损有关。因此，在为肥胖者提供护理时，应考虑 2 型糖尿病对肺功能的影响。
