Kim H-K, Kim C-H, Jung Y J, Bae S J, Choe J, Park J Y, Lee K-U
Health Promotion Center, Asan Medical Center, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea.
Exp Clin Endocrinol Diabetes. 2011 Jan;119(1):47-52. doi: 10.1055/s-0030-1268467. Epub 2011 Jan 18.
To investigate associations of obstructive and restrictive patterns of ventilatory dysfunction with insulin resistance and type 2 diabetes mellitus (DM) in Koreans.
We cross-sectionally examined clinical, laboratory, and pulmonary function data on 35,456 Korean adults (age 18-93 years, 40% women) recorded during regular health check-ups. Insulin resistance (IR) was determined from fasting serum insulin concentration and homeostasis model assessment (HOMA).
Individuals with type 2 DM and those with pre-diabetes (impaired fasting glucose levels) showed a higher prevalence of both restrictive (18% and 11%, respectively, VS. 8%; P<0.01) and obstructive (4.3% and 3.2%, respectively, VS. 2.3%; P<0.01) ventilatory dysfunction than did individuals with normal fasting glucose levels. Compared to subjects with normal ventilatory function, those with restrictive or obstructive ventilatory dysfunction were older, had higher systolic and diastolic blood pressure, and had elevated glucose and HbA1c levels. However, serum triglyceride, fasting insulin, and HOMA-IR were higher only in subjects with restrictive ventilatory dysfunction, and not in those with obstructive ventilatory dysfunction. On logistic regression analysis, the age and gender-adjusted odds ratio (OR) of restrictive ventilatory dysfunction for type 2 DM was 1.59 (95% confidence interval, 1.43-1.78). The increased OR remained significant after controlling for exercise, drinking, and smoking habits, presence of hypertension, body mass index, and waist circumference (OR=1.38 [1.23-1.55]). However, further adjustment for HOMA-IR attenuated the OR (1.11 [0.97-1.26]), making the OR statistically insignificant. In contrast, obstructive ventilatory dysfunction was not independently related to type 2 DM status.
Restrictive ventilatory dysfunction is independently associated with type 2 DM, probably VIA insulin resistance.
研究韩国人通气功能障碍的阻塞性和限制性模式与胰岛素抵抗及2型糖尿病（DM）之间的关联。
我们对35456名韩国成年人（年龄18 - 93岁，40%为女性）在定期健康检查期间记录的临床、实验室和肺功能数据进行了横断面研究。胰岛素抵抗（IR）通过空腹血清胰岛素浓度和稳态模型评估（HOMA）来确定。
2型糖尿病患者和糖尿病前期（空腹血糖受损）患者的限制性通气功能障碍（分别为18%和11%，相比正常空腹血糖水平者的8%；P<0.01）和阻塞性通气功能障碍（分别为4.3%和3.2%，相比正常空腹血糖水平者的2.3%；P<0.01）的患病率均高于空腹血糖正常者。与通气功能正常的受试者相比，存在限制性或阻塞性通气功能障碍的受试者年龄更大，收缩压和舒张压更高，血糖和糖化血红蛋白（HbA1c）水平升高。然而，血清甘油三酯、空腹胰岛素和HOMA-IR仅在存在限制性通气功能障碍的受试者中升高，而在存在阻塞性通气功能障碍的受试者中未升高。在逻辑回归分析中，2型糖尿病患者发生限制性通气功能障碍的年龄和性别调整后的优势比（OR）为1.59（95%置信区间，1.43 - 1.78）。在控制运动、饮酒和吸烟习惯、高血压、体重指数和腰围后，增加的OR仍然显著（OR = 1.38 [1.23 - 1.55]）。然而，进一步调整HOMA-IR后，OR减弱（1.11 [0.97 - 1.26]），使OR无统计学意义。相比之下，阻塞性通气功能障碍与2型糖尿病状态无独立关联。
限制性通气功能障碍与2型糖尿病独立相关，可能是通过胰岛素抵抗。
