Klein Oana L, Aviles-Santa Larissa, Cai Jianwen, Collard Harold R, Kanaya Alka M, Kaplan Robert C, Kinney Gregory L, Mendes Eliana, Smith Lewis, Talavera Gregory, Wu Donghong, Daviglus Martha
Department of Medicine, University of California, San Francisco, San Francisco, CA
National Heart, Lung, and Blood Institute, Bethesda, MD.
Diabetes Care. 2016 Nov;39(11):2051-2057. doi: 10.2337/dc16-1170. Epub 2016 Sep 9.
Type 2 diabetes mellitus (DM) has been associated with lung dysfunction, but this association has not been explored in Hispanics/Latinos. The relation between diabetic nephropathy and lung function and symptoms has not been explored.
The Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a large, multicenter, observational study, recruited 16,415 participants aged 18-74 years (14,455 with complete data on variables of interest), between 2008 and 2011 from four U.S. communities through a two-stage area household probability design. Baseline measurements were used for analyses. Forced expiratory volume in 1 s (FEV), forced vital capacity (FVC), and dyspnea score were compared between individuals with and without DM, overall, and stratified by albuminuria. The analyses were performed separately for those with and without preexisting lung disease (chronic bronchitis, emphysema, asthma). Linear regression with sampling weights was used for all analyses.
Among Hispanics/Latinos without lung disease, those with DM had lower mean FEV and FVC values and a higher mean dyspnea score than those without DM (mean [95% CI] FEV 3.00 [2.96-3.04] vs. 3.10 [3.09-3.11] L, P < 0.01; FVC 3.62 [3.59-3.66] vs. 3.81 [3.79-3.83] L, P < 0.001; dyspnea score 0.60 [0.49-0.71] vs. 0.41 [0.34-0.49], P < 0.001). Hispanics/Latinos with DM and macroalbuminuria showed 10% lower FVC (P < 0.001), 6% lower FEV (P < 0.001), and 2.5-fold higher dyspnea score (P = 0.04) than those without DM and with normoalbuminuria. Similar findings but with higher impairment in FVC were found in Hispanics/Latinos with lung disease.
Hispanics/Latinos with DM have functional and symptomatic pulmonary impairment that mirror kidney microangiopathy. The progression of pulmonary impairment in adults with DM needs to be investigated further.
2型糖尿病（DM）与肺功能障碍有关，但这种关联在西班牙裔/拉丁裔人群中尚未得到研究。糖尿病肾病与肺功能及症状之间的关系也未被探讨。
西班牙裔社区健康研究/拉丁裔研究（HCHS/SOL）是一项大型、多中心的观察性研究，于2008年至2011年期间，通过两阶段区域家庭概率设计，从美国四个社区招募了16415名年龄在18 - 74岁之间的参与者（14455名有感兴趣变量的完整数据）。基线测量用于分析。比较了有和没有DM的个体之间的1秒用力呼气量（FEV）、用力肺活量（FVC）和呼吸困难评分，总体上以及按蛋白尿分层进行比较。对有和没有既往肺部疾病（慢性支气管炎、肺气肿、哮喘）的个体分别进行分析。所有分析均使用带抽样权重的线性回归。
在没有肺部疾病的西班牙裔/拉丁裔人群中，患有DM的个体的平均FEV和FVC值低于没有DM的个体，平均呼吸困难评分高于没有DM的个体（平均值[95%CI]：FEV 3.00[2.96 - 3.04]L对3.10[3.09 - 3.11]L，P < 0.01；FVC 3.62[3.59 - 3.66]L对3.81[3.79 - 3.83]L，P < 0.001；呼吸困难评分0.60[0.49 - 0.71]对0.41[0.34 - 0.49]，P < 0.001）。患有DM和大量蛋白尿的西班牙裔/拉丁裔人群的FVC比没有DM和正常蛋白尿的人群低10%（P < 0.001），FEV低6%（P < 0.001），呼吸困难评分高2.5倍（P = 0.04）。在患有肺部疾病的西班牙裔/拉丁裔人群中发现了类似的结果，但FVC的损伤更严重。
患有DM的西班牙裔/拉丁裔人群存在功能性和症状性肺损伤，这与肾脏微血管病变相似。DM成年患者肺损伤的进展需要进一步研究。
