Wang Lu, Zhou Yicheng, Jiao Xiaojuan, Zhang Qin, Feng Kun, Shen Yunfeng
Department of Endocrinology and Metabolism, Nanchang University Second Affiliated Hospital, Nanchang, 330006, China.
Pingshan District People's Hospital of Shenzhen, Shenzhen, Guangdong, 518118, China.
BMC Pulm Med. 2024 Dec 21;24(1):628. doi: 10.1186/s12890-024-03376-0.
The association between glycemic control and short-, and long-term lung health remains controversial. This study aimed to investigate the relationship between glucose control and overall lung health in a national cohort.
The analysis included 5610 subjects from NHANES 2007-2012. We assessed the correlation of glycemic status with respiratory symptoms (cough, sputum, wheeze, and exertional dyspnea), lung function (forced expiratory volume in 1-s (FEV1), forced vital capacity (FVC)), and obstructive or restrictive lung disease (RLD). Furthermore, we determined all-cause mortality in patients with restrictive lung disease by linking data to the National Mortality Index records up to December 31, 2019.
The study involved the examination of respiratory symptoms, pulmonary function tests, and mortality analyses encompassing 3714, 3916, and 173 subjects, respectively. Multifactorial regression analyses revealed that a 1% increase in blood glucose was associated with a reduction in effect sizes (β) for FVC and FEV1 by -1.66% (-2.47%, -0.86%) and -1.94% (-2.65%, -1.23%), respectively. This increase also exhibited correlations with an elevated risk of exertional dyspnoea, restrictive ventilation dysfunction, and all-cause mortality, presenting odds ratios (ORs) of 1.19 (1.06, 1.33), 1.22 (1.10, 1.36), and 1.61 (1.29, 2.01), respectively. Regarding glycemic control, patients with improved control demonstrated stronger associations with early lung damage, significantly correlating with reduced FVC (β -10.90%, [-14.45%, -7.36%]) and FEV1 (β -9.38%, [-12.90%, -5.87%]). Moreover, they experienced a notably higher risk of exertional dyspnoea (adjusted OR 2.09, [1.35- 3.24]), while the diabetic group with poorer glycemic control showed more significant connections with advanced lung damage. This group exhibited significant associations with an increased risk of restrictive ventilatory dysfunction (adjusted OR, 2.56, [1.70-3.86]) and all-cause mortality (hazard ratios [HRs] 2.65, [1.05-6.67]), all compared to the reference group with normal glycemic metabolism.
Elevated blood glucose exhibited an inverse correlation with both long-term and short-term lung health. A negative L-shaped relationship was observed between glycemic control and early lung injury, along with a linearly negative association concerning late-stage lung damage. Given the cross-sectional nature of this study, a longitudinal investigation is needed to validate our findings.
血糖控制与短期和长期肺部健康之间的关联仍存在争议。本研究旨在调查全国队列中血糖控制与整体肺部健康之间的关系。
分析纳入了2007 - 2012年美国国家健康与营养检查调查（NHANES）的5610名受试者。我们评估了血糖状态与呼吸道症状（咳嗽、咳痰、喘息和劳力性呼吸困难）、肺功能（第1秒用力呼气容积（FEV1）、用力肺活量（FVC））以及阻塞性或限制性肺病（RLD）之间的相关性。此外，通过将数据与截至2019年12月31日的国家死亡率指数记录相链接，我们确定了限制性肺病患者的全因死亡率。
该研究分别对3714名、3916名和173名受试者进行了呼吸道症状检查、肺功能测试和死亡率分析。多因素回归分析显示，血糖每升高1%，FVC和FEV1的效应量（β）分别降低 - 1.66%（- 2.47%，- 0.86%）和 - 1.94%（- 2.65%，- 1.23%）。血糖升高还与劳力性呼吸困难风险增加、限制性通气功能障碍以及全因死亡率相关，其比值比（OR）分别为1.19（1.06，1.33）、1.22（1.10，1.36）和1.61（1.29，2.01）。关于血糖控制，血糖控制改善的患者与早期肺损伤的关联更强，与FVC降低（β - 10.90%，[- 14.45%，- 7.36%]）和FEV1降低（β - 9.38%，[- 12.90%，- 5.87%]）显著相关。此外，他们经历劳力性呼吸困难的风险显著更高（调整后的OR为2.09，[1.35 - 3.24]），而血糖控制较差的糖尿病组与晚期肺损伤的联系更为显著。与血糖代谢正常的参照组相比，该组与限制性通气功能障碍风险增加（调整后的OR为2.56，[1.70 - 3.86]）和全因死亡率（风险比[HRs]为2.65，[1.05 - 6.67]）显著相关。
血糖升高与短期和长期肺部健康均呈负相关。血糖控制与早期肺损伤之间观察到负L形关系，而与晚期肺损伤呈线性负相关。鉴于本研究的横断面性质，需要进行纵向调查以验证我们的发现。
