第1型糖尿病患者之心肺適能、肺功能、肌肉氧氣飽和度及生活品質

Abstract

背景：心肺適能對於第1型糖尿病患者是重要的與壽命相關，研究也顯示第1型糖尿病患者的心肺適能和肺功能較健康活動者為差。心肺適能與肺功能、肌肉氧氣飽和度或生活品質於第1型糖尿病患者的相關性尚須探討。 研究目的：本篇研究目的在（1）比較第1型糖尿病成年患者與健康人的心肺適能、肺功能、肌肉氧氣飽和度及生活品質，以及（2）第1型糖尿病患者於心肺適能、肺功能、肌肉氧氣飽和度、血糖控制及生活品質的相關性。 研究方法：本研究共徵招20位年齡33.5±10.1歲的第1型糖尿病患者，以及20位年齡、性別、身體質量指數相符的健康成人。測量兩組受試者的基本資料，包含糖尿病相關病史資料及習慣性身體活動能量消耗等。所有受試者皆接受症狀限制最大運動測試與同時之近紅外線光譜儀測試、肺功能測試包含肺部容積─流速測試和10秒單次呼吸法測得之肺部一氧化碳擴散容量（10-second single-breath DLCO）與36題短版生活品質量表（Short-Form 36）。 研究結果：相較於健康人，在調整身體活動量後，第1型糖尿病患者之最大攝氧量（26.2±6.7 vs. 31.5±6.2 ml/min/kg）、最大運動的動靜脈氧差（13.3±2.8 vs. 15.5±3.7 ml/100ml）及肺部一氧化碳擴散能力預期值（92±14 vs. 104±13% predicted）明顯為低。第1型糖尿病人在36題短版生活品質量表之總分亦顯著較低，且於一般健康、社交功能之次量表也有顯著較低的分數。最大攝氧量與用力肺活量、第一秒呼氣量、肺部一氧化碳擴散量、動靜脈氧差及身體活動量顯著中度相關。多元迴歸分析中，糖化血色素對於用力肺活量預期值（β=－0.52）及36題短版生活品質量表之總分（β=－0.49）具有顯著影響力，而身體活動量對於最大攝氧量預期值（β=0.45）及運動時的心搏量（β=0.52）有顯著影響。 結論：第1型糖尿病患者的心肺適能、氣體擴散能力及生活品質較健康人差，血糖控制及身體活動量對心肺適能、肺功能及生活品質有重要影響。第1型糖尿病患者應控制血糖及增加身體活動量以改善心肺適能及生活品質。 關鍵字：第1型糖尿病、心肺適能、肺功能、肌肉氧氣飽和度、生活品質、身體活動

Background: Cardiopulmonary fitness has been reported to correlate with life expectancy in patients with type 1 diabetes mellitus (T1DM). Compared to healthy exercisers, patients with T1DM tend to have reduced cardiopulmonary fitness and lung function. However, the interrelationships with lung function, muscular oxygen saturation, and quality of life (QOL) are yet to be investigated. Purpose: The purposes of this study were (1) to compare cardiopulmonary fitness, lung function, muscle oxygen saturation, and QOL between T1DM patients and healthy controls; and (2) to investigate the relationship between cardiopulmonary fitness and other variables of interest in T1DM patients. Methods: Twenty T1DM patients, aged 33.5±10.1 years, and 20 age-, gender-, and body mass index-matched healthy controls were recruited. Besides the basic and clinical characteristics, all participants took measurements of a symptom-limited exercise testing with concurrent near-infrared spectroscopy and bioreactance cardiac output monitoring, pulmonary function test with lung diffusing capacity (DLCO) measurement, and the Short-Form 36. Results: After adjusting physical activity, compared to healthy controls, T1DM patients had significantly lower VO2peak (26.2±6.7 ml/min/kg vs. 31.5±6.2 ml/min/kg), (a-v)O2diff at peak exercise (13.3±2.8 vs. 15.5±3.7 ml/100ml), DLCO (92±14 vs. 104±13% predicted), and lower total score in SF-36 and subscales of general healthand social functioning. VO2peak was moderately correlated with FVC, FEV1, DLCO, (a-v)O2diff, and physical activity level. In multiple regression analysis, HbA1C had significant impact on %predicted FVC (β=－0.52) and SF-36 total score, while physical activity level significantly correlated with %predicted VO2 and stroke volume at peak exercise. Conclusion: Patients with T1DM had lower cardiopulmonary fitness, lung diffusing capacity and QOL than their healthy controls. Glycemic control and physical activity significantly correlated with cardiopulmonary fitness, lung function, and QOL, thus it is important to improve their glycemic control and physical activity level clinically.