Kim Chul-Hee, Kim Hong-Kyu, Kim Eun-Hee, Bae Sung-Jin, Jung Young-Ju, Choi Jaewon, Park Joong-Yeol
Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, South Korea.
Acta Diabetol. 2015 Apr;52(2):357-63. doi: 10.1007/s00592-014-0649-0. Epub 2014 Oct 26.
This study was performed to investigate whether ventilatory dysfunction is a predictor for the development of prediabetes and type 2 diabetes in Koreans.
We analyzed the clinical and laboratory data of 16,195 Korean adults (age 20-79 years) who underwent routine medical checkups with a mean 4.7-years (range 3.0-5.9 years) interval. Spirometry results were categorized into three patterns: normal, obstructive ventilatory dysfunction [OVD; forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) <0.70], and restrictive ventilatory dysfunction (RVD; FVC < 80 % predicted, FEV1/FVC ≥ 0.70).
Compared with subjects with normal ventilatory function, subjects with RVD had a higher incidence of type 2 diabetes (3.7 vs. 6.3 %; P < 0.001), whereas subjects with OVD did not (3.7 vs. 4.8 %; P = 0.119). On multivariate logistic regression analysis, the odds ratio (OR) of RVD for type 2 diabetes was significantly increased after adjusting for age, sex, and lifestyle factors (1.40; 95 % CI 1.10-1.78). However, further adjustment for body mass index (BMI), waist circumference, and baseline glucose level attenuated the OR to become insignificant (1.12; 95 % CI 0.86-1.47). Among the 9,461 participants who had normal fasting glucose and HbA1c levels at baseline, the OR for progression to prediabetes or diabetes in the RVD group was significantly increased (1.30; 95 % CI 1.12-1.51). The increased OR remained significant after adjusting for BMI, waist circumference, and baseline glucose level (1.26; 95 % CI 1.07-1.47).
Our results indicate that restrictive, but not obstructive ventilatory dysfunction, is independently associated with development of prediabetes and precedes the development of type 2 diabetes.
本研究旨在调查通气功能障碍是否是韩国人糖尿病前期和2型糖尿病发生的预测因素。
我们分析了16195名韩国成年人（年龄20 - 79岁）的临床和实验室数据，这些人接受了常规体检，平均间隔时间为4.7年（范围3.0 - 5.9年）。肺量计检测结果分为三种模式：正常、阻塞性通气功能障碍[OVD；1秒用力呼气量（FEV1）/用力肺活量（FVC）<0.70]和限制性通气功能障碍（RVD；FVC<预测值的80%，FEV1/FVC≥0.70）。
与通气功能正常的受试者相比，RVD受试者的2型糖尿病发病率更高（3.7%对6.3%；P<0.001），而OVD受试者则不然（3.7%对4.8%；P = 0.119）。在多因素逻辑回归分析中，调整年龄、性别和生活方式因素后，RVD患2型糖尿病的比值比（OR）显著增加（1.40；95%CI 1.10 - 1.78）。然而，进一步调整体重指数（BMI）、腰围和基线血糖水平后，OR减弱至无统计学意义（1.12；95%CI 0.86 - 1.47）。在基线时空腹血糖和糖化血红蛋白水平正常的9461名参与者中，RVD组进展为糖尿病前期或糖尿病的OR显著增加（1.30；95%CI 1.12 - 1.51）。调整BMI、腰围和基线血糖水平后，增加的OR仍具有统计学意义（1.26；95%CI 1.07 - 1.47）。
我们的结果表明，限制性通气功能障碍而非阻塞性通气功能障碍与糖尿病前期的发生独立相关，并先于2型糖尿病的发生。
