Abstract: Background　Currently, there are 537 million patients with diabetes mellitus in the world, with the greatest number of affected people in China. Accumulating studies have found that the lungs are also the target organs of diabetes mellitus. Previous cross-sectional studies on diabetes mellitus and lung function have consistently concluded that people with diabetes mellitus have lower lung function than unaffected individuals. However, longitudinal studies are scant on diabetes mellitus and the decline rate of lung function, and the existing conclusions are inconsistent. Objective　To investigate the association between diabetes mellitus and lung function in male people. Methods　From 2014 to 2020, 18 438 male employees receiving lung function test and other physical examinations in Kailuan General Hospital were involved in this study, including 12 448 who completed the second lung function test. They were assigned into the normal fasting plasma glucose group (FPG<6.1 mmol/L, n=15 727), impaired fasting glucose group (IFG group, 6.1 mmol/L ≤ FPG<7 mmol/L, n=1 490) and diabetes mellitus group (FPG ≥ 7.0 mmol/L or a history of diabetes mellitus, or use of hypoglycemic drugs, n=1 221) based on the blood glucose levels. A generalized linear model was used to analyze the association of different blood glucose levels with lung function indicators [FVC%pred (percentage of predicted value for forced vital capacity), FEV1%pred (percentage of predicted value for forced expiratory volume in one second), MMEF% (percentage of predicted value for maximum mid-expiratory flow), and FEV1/FVC (the ratio of forced expiratory flow in one second to forced vital capacity)] and decline rate of lung function. Results　Among the 18 438 observed subjects，the average age was 42.90±9.73 years. FVC%pred and FEV1%pred were significantly lower in the diabetes mellitus group than the normal FPG and IFG groups, and MMEF%pred was significantly higher in the IFG group than the normal FPG and diabetes mellitus group (P<0.05). No significant difference was found in the decline rate of lung function among the three groups (P>0.05). After adjusting for confounders, the generalized linear analysis showed that with the reference of the normal FPG group, diabetes mellitus was negatively correlated with FVC%pred (B=-1.000, 95%CI=-1.784 to -0.218, P=0.012) and FEV1%pred (B=-1.266, 95%CI=-2.236 to -0.296, P=0.011), but not associated with MMEF%pred and FEV1/FVC (P>0.05). There was no correlation between IFG and diabetes with the decline rate of lung function indicators (P>0.05). Conclusion　Diabetes mellitus are negatively associated with lung function indicators (FVC%pred, FEV1%pred) in male people. However，we did not find an association of diabetes mellitus with the decline rate of lung function in men.

Key words: Diabetes mellitus, Pulmonary function, Men, Impaired fasting glucose, Generalized linear model analysis, Tangshan city

摘要： 背景　目前全球糖尿病患者已达5.37亿，我国糖尿病患者人数最多，越来越多的研究发现肺脏也是糖尿病的靶器官。以往关于糖尿病与肺功能的横断面研究结论基本一致：与非糖尿病人群相比，糖尿病人群的肺功能更低。然而，对于糖尿病和肺功能下降速度的纵向研究较少，且目前研究结论并不一致。目的　探讨男性人群糖尿病和肺功能的相关性。方法　选取2014—2020年参加包括肺功能检查在内的开滦健康体检的男性开滦职工为研究对象，最终纳入18 438例（其中完成第二次肺功能检查的为12 448例）。根据观察对象的血糖水平分为3组：空腹血糖（FPG）正常组（FPG<6.1 mmol/L）15 727例、空腹血糖受损（IFG）组（6.1 mmol/L≤FPG<7 mmol/L）1 490例、糖尿病组（FPG≥7.0 mmol/L或有糖尿病史或正在服用降糖药）1 221例。采用广义线性模型分析不同血糖水平与肺功能指标［用力肺活量占预计值百分比（FVC%pred）、第1秒用力呼气容积占预计值百分比（FEV1%pred）、最大呼气中期流量占预计值百分比（MMEF%pred）、第1秒用力肺活量与用力肺活量比值（FEV1/FVC）］及相关肺功能指标下降速度的关联。结果　18 438例研究对象的年龄平均为（42.90±9.73）岁。糖尿病组FVC%pred、FEV1%pred水平低于FPG正常组和IFG组，IFG组MMEF%pred水平高于FPG正常组和糖尿病组（P<0.05）；3组研究对象肺功能下降速度比较，差异均无统计学意义（P>0.05）。校正相关变量后，广义线性模型分析结果显示（以FPG正常组为参照），糖尿病与FVC%pred（B=-1.000，95%CI=-1.784~-0.218，P=0.012）、FEV1%pred（B=-1.266，95%CI=-2.236~-0.296，P=0.011）均呈负相关，与MMEF%pred、FEV1/FVC无相关性（P>0.05）；IFG、糖尿病与肺功能指标下降速度均无相关性（P>0.05）。结论　糖尿病与男性肺功能指标（FVC%pred、FEV1%pred）呈负向关联，但是未发现糖尿病与男性肺功能指标下降速度有关。

关键词: 糖尿病, 肺功能, 男人, 空腹血糖受损, 广义线性模型分析, 唐山市