Trends in pulmonary function in patients with cystic fibrosis correlate with the degree of glucose intolerance at baseline
Trends in pulmonary function in patients with cystic fibrosis correlate with the degree of glucose intolerance at baseline
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DOI：
10.1164/ajrccm.162.3.9904075
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发表时间：
2000-09-01
影响因子：
24.7
通讯作者：
Moran, A
中科院分区：
文献类型：
--
作者：
Milla, CE;Warwick, WJ;Moran, A
在囊性纤维化患者中，cf相关性糖尿病（CFRD）与发病率和死亡率增加有关。葡萄糖耐受不良是否也与不良预后相关尚不清楚。为了更好地定义这些关系，我们对152例无糖尿病的CF患者进行了4年的前瞻性随访，患者被分为糖耐量正常（NGT）、糖耐量受损（IGT）或无空腹高血糖的CFRD （CFRD- no FH）。在基线和季度测量FEV1、FVC和体重指数（BMI）。基线时，45%的患者有NGT， 38.8%有IGT， 15.8%有CFRD-No FH。两组间FEV1、FVC和BMI基线值具有可比性（均p < 0.1）。4年后，FEV1和FVC总体下降，BMI没有变化。FEV1和FVC的下降率与糖耐量组相关，CFRD-No FH组的下降率最高。此外，基线时胰岛素分泌最低的四分位数患者随着时间的推移，肺功能下降的比率最高，这表明胰岛素缺乏与临床恶化之间存在关系。我们得出结论，葡萄糖耐受不良程度是CF患者未来肺功能下降的重要决定因素。
In patients with cystic fibrosis, CF-related diabetes mellitus (CFRD) has been associated with increased morbidity and mortality. Whether glucose intolerance is also associated with poor outcomes is unclear. To better define these relationships we prospectively followed a group of 152 patients with CF without diabetes for 4 yr, Patients were classified as having normal glucose tolerance (NGT), impaired glucose tolerance (IGT), or CFRD without fasting hyperglycemia (CFRD-No FH). FEV1, FVC, and body mass index (BMI) were measured at baseline and quarterly. At baseline 45% of the patients had NGT, 38.8% had IGT, and 15.8% had CFRD-No FH. FEV1, FVC, and BMI at baseline were comparable among these groups (all p > 0.1). After 4 yr an overall decline in FEV1 and FVC occurred, with no change in BMI. The rates of decline for FEV1 and FVC correlated with the glucose tolerance groups, with the highest rates of decline occurring among the CFRD-No FH group. In addition, patients in the lowest quartile for insulin production at baseline experienced the highest rates of pulmonary function decline over time, suggesting a relationship between insulin deficiency and clinical deterioration. We conclude that the degree of glucose intolerance is a strong determinant of future lung function decline in patients with CF.