糖尿病与哮喘的关系：韩国一项全国性研究
2020/01/08
摘要
背景：通过大规模收集韩国人群的相关数据，探究2型糖尿病对哮喘的影响。
目的：2型糖尿病和哮喘有共同的病理生理学特征——慢性炎症。然而，目前尚未明确2型糖尿病是否能增加哮喘的患病风险。
方法：本研究共纳入13154348名受试者，所有数据均来源于2005-2008年间在韩国国民健康保险机构参与定期健康体检的人群。依据受试者糖尿病（DM）和糖尿病视网膜病变（DR）的罹患情况进行分类，研究终点为发生哮喘、死亡或者2013年12月31日。通过Cox比例风险回归模型评估伴随或未伴随视网膜病变的糖尿病对哮喘发生发展的影响。
结果：无糖尿病组、有糖尿病但无糖尿病视网膜病变组和有糖尿病及糖尿病视网膜病变组患者中哮喘的年平均发病率分别为27.1/1000、30.1/1000和38.4/1000。 Cox比例风险多元回归模型结果显示，无糖尿病视网膜病变的糖尿病患者发生哮喘的风险显著低于无糖尿病患者（风险比，0.943; 95％置信区间，0.939-0.948）。相反，患有视网膜病变的糖尿病患者罹患哮喘的风险则较无糖尿病患者高（风险比，1.067; 95％置信区间，1.053-1.081）。
结论：无视网膜病变的2型糖尿病不是哮喘发生发展的危险因素。而存在糖尿病视网膜病变的糖尿病患者发生哮喘的风险则增高，这一结果与肺是糖尿病损伤的靶器官的观点相符。未来需要更多研究探讨适当血糖控制能否降低糖尿病患者发生哮喘的风险。
17. Association between diabetes and asthma: Evidence from a nationwide Korean study
Baek JY, et al. Ann Allergy Asthma Immunol. 2018 Dec.
Abstract
BACKGROUND: Type 2 diabetes and asthma share a common pathophysiology: "chronic inflammation." However, it is unclear whether patients with type 2 diabetes are at increased risk of asthma.
OBJECTIVE: To investigate the effect of type 2 diabetes on asthma using data from a large population-based study in Korea.
METHODS: Data from the Korean National Health Insurance Service identified 13,154,348 participants who underwent regular health checkups from 2005 to 2008. Subjects were classified according to status of diabetes mellitus (DM) and diabetic retinopathy (DR), and followed until the date of asthma development, death, or December 31, 2013. Cox proportional hazard regression analysis was used to evaluate the effect of diabetes, with or without retinopathy, on asthma development.
RESULTS: The incidences of asthma in the non-DM, DM without DR, and DR groups were 27.1, 30.1, and 38.4 per 1,000 person-years, respectively. Cox proportional hazard multiple regression models revealed that diabetic patients without retinopathy had a significantly lower risk of developing asthma than non-DM subjects (hazard ratio, 0.943; 95% confidence interval, 0.939-0.948). By contrast, diabetic patients with retinopathy had a higher risk of developing asthma (hazard ratio, 1.067; 95% confidence interval, 1.053-1.081).
CONCLUSION: Type 2 diabetes without retinopathy is not a risk factor for asthma development. However, patients with DR are at a greater risk of incident asthma, supporting the notion that the lung is a target organ for diabetic injury. Future studies will address whether proper glycemic control mitigates the risk of asthma.
背景：通过大规模收集韩国人群的相关数据，探究2型糖尿病对哮喘的影响。
目的：2型糖尿病和哮喘有共同的病理生理学特征——慢性炎症。然而，目前尚未明确2型糖尿病是否能增加哮喘的患病风险。
方法：本研究共纳入13154348名受试者，所有数据均来源于2005-2008年间在韩国国民健康保险机构参与定期健康体检的人群。依据受试者糖尿病（DM）和糖尿病视网膜病变（DR）的罹患情况进行分类，研究终点为发生哮喘、死亡或者2013年12月31日。通过Cox比例风险回归模型评估伴随或未伴随视网膜病变的糖尿病对哮喘发生发展的影响。
结果：无糖尿病组、有糖尿病但无糖尿病视网膜病变组和有糖尿病及糖尿病视网膜病变组患者中哮喘的年平均发病率分别为27.1/1000、30.1/1000和38.4/1000。 Cox比例风险多元回归模型结果显示，无糖尿病视网膜病变的糖尿病患者发生哮喘的风险显著低于无糖尿病患者（风险比，0.943; 95％置信区间，0.939-0.948）。相反，患有视网膜病变的糖尿病患者罹患哮喘的风险则较无糖尿病患者高（风险比，1.067; 95％置信区间，1.053-1.081）。
结论：无视网膜病变的2型糖尿病不是哮喘发生发展的危险因素。而存在糖尿病视网膜病变的糖尿病患者发生哮喘的风险则增高，这一结果与肺是糖尿病损伤的靶器官的观点相符。未来需要更多研究探讨适当血糖控制能否降低糖尿病患者发生哮喘的风险。
(中国医科大学附属一院呼吸与危重症学科 李文扬 摘译 杨冬 审校)
(Baek JY, et al. Ann Allergy Asthma Immunol. 2018 Dec.)
(Baek JY, et al. Ann Allergy Asthma Immunol. 2018 Dec.)
17. Association between diabetes and asthma: Evidence from a nationwide Korean study
Baek JY, et al. Ann Allergy Asthma Immunol. 2018 Dec.
Abstract
BACKGROUND: Type 2 diabetes and asthma share a common pathophysiology: "chronic inflammation." However, it is unclear whether patients with type 2 diabetes are at increased risk of asthma.
OBJECTIVE: To investigate the effect of type 2 diabetes on asthma using data from a large population-based study in Korea.
METHODS: Data from the Korean National Health Insurance Service identified 13,154,348 participants who underwent regular health checkups from 2005 to 2008. Subjects were classified according to status of diabetes mellitus (DM) and diabetic retinopathy (DR), and followed until the date of asthma development, death, or December 31, 2013. Cox proportional hazard regression analysis was used to evaluate the effect of diabetes, with or without retinopathy, on asthma development.
RESULTS: The incidences of asthma in the non-DM, DM without DR, and DR groups were 27.1, 30.1, and 38.4 per 1,000 person-years, respectively. Cox proportional hazard multiple regression models revealed that diabetic patients without retinopathy had a significantly lower risk of developing asthma than non-DM subjects (hazard ratio, 0.943; 95% confidence interval, 0.939-0.948). By contrast, diabetic patients with retinopathy had a higher risk of developing asthma (hazard ratio, 1.067; 95% confidence interval, 1.053-1.081).
CONCLUSION: Type 2 diabetes without retinopathy is not a risk factor for asthma development. However, patients with DR are at a greater risk of incident asthma, supporting the notion that the lung is a target organ for diabetic injury. Future studies will address whether proper glycemic control mitigates the risk of asthma.
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