Jiang Fei, Chen Miao, Hu Cheng, Bao Yuqian, Jia Weiping
Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai Clinical Center for Metabolic Disease, Shanghai Key Laboratory of Diabetes Mellitus, Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China. Email:
Zhonghua Nei Ke Za Zhi. 2014 Nov;53(11):858-64.
This study aimed to assess the effects of active and passive smoking on chronic kidney disease (CKD) in patients with type 2 diabetes mellitus (T2DM).
Seven hundred and five patients with T2DM were recruited in the study and were divided into three groups based on smoking status as active smokers, passive smokers and non-smokers. Twenty-four hour urinary albumin excretion (24hUAE) was measured, and estimate glomerular filtration rate (eGFR) was calculated with age and blood creatinine levels.
(1)The proportion of CKD in T2DM in the present study was 31.63% (223/705) with 28.6% (22/77) , 30.0% (15/50) and 29.6% (73/247) for non-smokers, passive smokers and active smokers in men, and 29.9% (40/134), 35.9% (66/184) and 7/13 for non-smokers, passive smokers and active smokers in women, respectively. In comparison with non-smokers, a higher risk of CKD was found in both passive and active smokers (OR = 1.07 and OR = 1.05 in men; OR = 1.31 and OR = 2.74 in women, respectively). (2) Compared with non-smokers, passive smokers had a significant higher risk for albuminuria in women (OR = 2.02, P = 0.016) . (3) After adjusting for gender, age, duration of T2DM, BMI, systolic blood pressure, glycosylated hemoglobin A1C and lipids, there was a significant decrease in eGFR between active and never smokers (P = 0.018) or passive smokers (P = 0.000) in women. No differences could be found in eGFR between each smoking statues in men.
Smoking exposure alone confers a high risk for CKD in patients with T2DM. Our results highlight an importance in implementation of a smoke-free environment for patients with T2DM.
本研究旨在评估主动吸烟和被动吸烟对2型糖尿病（T2DM）患者慢性肾脏病（CKD）的影响。
本研究招募了705例T2DM患者，并根据吸烟状况分为三组，即主动吸烟者、被动吸烟者和非吸烟者。测量24小时尿白蛋白排泄量（24hUAE），并根据年龄和血肌酐水平计算估计肾小球滤过率（eGFR）。
（1）本研究中T2DM患者的CKD比例为31.63%（223/705），男性非吸烟者、被动吸烟者和主动吸烟者的比例分别为28.6%（22/77）、30.0%（15/50）和29.6%（73/247），女性非吸烟者、被动吸烟者和主动吸烟者的比例分别为29.9%（40/134）、35.9%（66/184）和7/13。与非吸烟者相比，被动吸烟者和主动吸烟者患CKD的风险更高（男性的OR分别为1.07和1.05；女性的OR分别为1.31和2.74）。（2）与非吸烟者相比，女性被动吸烟者患蛋白尿的风险显著更高（OR = 2.02，P = 0.016）。（3）在调整性别、年龄、T2DM病程、BMI、收缩压、糖化血红蛋白A1C和血脂后，女性中主动吸烟者与从不吸烟者（P = 0.018）或被动吸烟者（P = 0.000）之间的eGFR有显著下降。男性各吸烟状态之间的eGFR未发现差异。
仅吸烟暴露就使T2DM患者患CKD的风险很高。我们的结果凸显了为T2DM患者营造无烟环境的重要性。
