吸烟对职业人群胰岛素分泌和胰岛素抵抗功能影响  

Impact of smoking on isletβ-cell function and insulin resistance among healthy workmen in a chemical plant:a cross-sectional analysis

作　　者：丁甘玲 陈冲 汪嘉琦 张永青[2] 涂青云 张琳[3] 向全永[1,2] DING Gan-ling;CHEN Chong;WANG Jia-qi(School of Public Health,Southeast University,Nanjing,Jiangsu Province 210009,China;不详)

机构地区：[1]东南大学公共卫生学院,江苏南京210009 [2]江苏省疾病预防控制中心 [3]南京江北人民医院

出　　处：《中国公共卫生》2021年第5期887-892,共6页Chinese Journal of Public Health

基　　金：国家自然科学基金(81573199,81973005)。

摘　　要：目的了解江苏省南京某大型化工企业男性职业人群吸烟状态与胰岛素抵抗和胰岛β细胞功能之间的关系,为职业人群糖尿病防治提供依据。方法于2018年6—12月选取该企业储运车间和化机车间的3135名男性职业人群为调查对象。根据其不同的吸烟包年数分成不吸烟、轻度吸烟、中度和重度吸烟4组,采用稳态模型(homeostasis model assessment,HOMA)计算出每个对象相应的胰岛素抵抗指数(HOMA-IR)和胰岛β细胞分泌功能指数(HOMA-β),用二分类logistic回归计算吸烟组的OR值。将调查对象每日平均吸烟支数分成0支、1~15支和>15支,采用logistic回归计算OR值。结果该职业人群的糖尿病患病率为6.35%[以空腹血糖(FPG)≥7.0 mmol/L和/或糖化血红蛋白(HbA1c)≥6.5%为标准],随着吸烟量的增加,HbA1C、空腹血糖逐渐升高,空腹胰岛素、HOMA-β逐渐降低,且有显著的剂量–效应关系,HOMA-IR在轻度吸烟者中显著增加,中度和重度吸烟者中逐渐降低。重度吸烟的胰岛β细胞分泌功能缺乏是不吸烟组的3.57倍(95%CI=2.77~4.59),相关变量调整后的OR值是1.64(95%CI=1.22~2.22)。平均每日吸烟>15支人群的胰岛β细胞分泌功能缺乏危险是不吸烟的1.62倍(95%CI=1.33~1.99),变量调整后的OR值是1.10(95%CI=0.87~1.40)。结论吸烟可以剂量依赖性引起胰岛细胞分泌功能下降,且可引起一定程度的胰岛素抵抗。Objective To explore the association of smoking with insulin resistance and isletβ-cell function among healthy workmen in a large chemical plant in Nanjing city and to provide evidences for diabetes prevention and control in occupational populations.Methods We recruited 3366 male workers without cardiovascular and cerebrovascular diseases,kidney disease,tumor,and diabetes and hazardous occupational exposures in two workshops of a large chemical plant and assigned the workers into a non-smoking,light,moderate,and heavy smoking groups based on their packets of cigarettes smoked per year.Questionnaire interviews,physical examination and laboratory detections were conducted among the workers during June–December 2018.The indexes of homeostasis model assessment-insulin resistance(HOMA-IR)and homeostasis model assessment-βcell function(HOMA-β)were calculated for all the workers.Binary logistic regression was adopted to assess the impact of smoking on HOMA-IR/β.Results For the 3135 workmen(mean age:43.45±10.95 years)with valid information,the detection rate of diabetes(fasting plasma glucose[FPG]≥7.0 mmol/L or/and hemoglobin A1 c[HbA1 c]≥6.5%)was 6.35%.With the increment of number of cigarettes smoked per day,the FPG and HbA1 c increased but the fasting blood insulin and HOMA-βdecreased gradually in a dose-response manner.The HOMA-IR increased significantly in light smokers but decreased in moderate and heavy smokers.Compared to the non-smokers,the heavy smokers were at a higher risk for HOMA-IR decline,with an odds ratio(OR)of 3.57(95%confidence interval[95%CI]=2.77–4.59)and an adjusted OR of 1.64(95%CI=1.22–2.22);in comparison with the non-smokers,the smokers with>15 cigarettes smoked per day had a higher risk of HOMA-IR decline,with an OR of 1.62(95%CI=1.33–1.99)and an adjusted OR of 1.10(95%CI=0.87–1.40).Conclusion Smoking could induce a dose-dependent decrease in isletβ-cell function and cause insulin resistance in some extent.

关 键 词：职业人群 吸烟 胰岛素抵抗指数 胰岛β细胞分泌功能指数 

分 类 号：R181.38[医药卫生—流行病学]