囊性纤维化患者葡萄糖耐量异常作为肺功能和临床状况的决定因素。
Glucose intolerance in cystic fibrosis as a determinant of pulmonary function and clinical status.
机构信息
Pediatric Pulmonary Unit and The National Center for Cystic Fibrosis, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel(1).
Pediatric Pulmonary Unit and The National Center for Cystic Fibrosis, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel(1).
出版信息
Diabetes Res Clin Pract. 2015 Dec;110(3):276-84. doi: 10.1016/j.diabres.2015.10.007. Epub 2015 Oct 14.
BACKGROUND
Cystic fibrosis related diabetes (CFRD) is associated with a decrease in pulmonary function and nutritional status. We investigated the clinical significance of impaired glucose tolerance (IGT) in cystic fibrosis (CF) patients.
METHODS
Fifty-five CF patients (aged 22.8 ± 9.2 years, 29 males, mean FEV1 67.9 ± 22% predicted, mean BMI-SDS -0.23 ± 1.1) underwent a 2-h Oral Glucose Tolerance Test (OGTT) with 30-min interval measurements of glucose and insulin. Additional clinical and laboratory data were obtained from the medical charts.
RESULTS
Thirty-eight participants (69%) had normal glucose tolerance (NGT), 13 (23.7%) had IGT, and 4 (7.3%) had newly diagnosed CFRD. Compared to patients with NGT, patients with IGT had significantly lower BMI-SDS (-1.1 ± 0.8 vs. 0.1 ± 1.1, p<0.001), mean FEV1 (57 ± 19 vs. 74 ± 21% predicted, p<0.01), and albumin (3.9 ± 0.3 vs. 4.3 ± 0.2g/dl, p=0.004), and higher fibrinogen (376 ± 56 vs. 327 ± 48 g/dl, p=0.02). Patients with IGT had impaired β-cell function, with reduced first phase insulin secretion, a delayed insulin peak, and significantly lower total insulin secretion, HOMA-%B and insulinogenic index. Seven patients had HbA1c in the "diabetic" range (≥6.5%; 47.5 mmol/mol), however, HbA1c was not a sensitive or specific marker of glucose tolerance status.
CONCLUSIONS
IGT in CF patients is associated with increased inflammation and decreased nutritional status and pulmonary function.
背景
囊性纤维化相关糖尿病（CFRD）与肺功能和营养状况下降有关。我们研究了糖耐量受损（IGT）在囊性纤维化（CF）患者中的临床意义。
方法
55 名 CF 患者（年龄 22.8 ± 9.2 岁，男性 29 名，平均 FEV1 67.9 ± 22%预计值，平均 BMI-SDS -0.23 ± 1.1）接受了 2 小时口服葡萄糖耐量试验（OGTT），每隔 30 分钟测量一次血糖和胰岛素。从病历中获得了其他临床和实验室数据。
结果
38 名参与者（69%）有正常的葡萄糖耐量（NGT），13 名（23.7%）有 IGT，4 名（7.3%）有新诊断的 CFRD。与 NGT 患者相比，IGT 患者的 BMI-SDS 明显更低（-1.1 ± 0.8 与 0.1 ± 1.1，p<0.001），平均 FEV1 更低（57 ± 19 与 74 ± 21%预计值，p<0.01），白蛋白更低（3.9 ± 0.3 与 4.3 ± 0.2g/dl，p=0.004），纤维蛋白原更高（376 ± 56 与 327 ± 48 g/dl，p=0.02）。IGT 患者的β细胞功能受损，第一时相胰岛素分泌减少，胰岛素峰值延迟，总胰岛素分泌、HOMA-%B 和胰岛素生成指数明显降低。7 名患者的 HbA1c 处于“糖尿病”范围（≥6.5%；47.5mmol/mol），但 HbA1c 不是葡萄糖耐量状态的敏感或特异性标志物。
结论
CF 患者的 IGT 与炎症增加、营养状况和肺功能下降有关。
Zotero 插件