The Interaction Of Different Smoking Status With Clinical Indexes And FGF21 In Patients With Type 2 Diabetes Mellitus

Objective:To explore the interaction between different smoking status and clinical indexes and fibroblast growth factor 21(FGF21)in patients with type 2 diabetes mellitus(T2DM).Methods:The 201 T2 DM patients in the Department of endocrinology of Qinhuangdao first hospital were selected as the subjects.According to the different smoking status of the subjects,they were divided into active smoking group,passive smoking group and non-smoking group.The general information?waist circumference(WC)?hip circumference(HC)?waist hip ratio(WHR)?fasting plasma glucose(FPG)?hemoglobin A1c(Hb A1c)?fasting C-peptide(FCP)?total cholesterol(TC)?triglyceride(TG)?low density lipoprotein-cholesterol(LDL-C)?high density lipoprotein-cholesterol(HDL-C)? urinary albumin-to-creatinine ratio(u ACR)?urea nitrogen,(UN)?creatinine(Cr)?uric acid(UA)?alanine aminotransferase(ALT)?aspartate aminotransferase(AST)?glutamyl transpeptidase(GGT)and FGF21 levels of the subjects were recorded,and the differences of each index among different groups were compared.Pearson or Spearman correlation analysis was used to analyze the relevant factors of active smoking index,passive smoking index and FGF21.Stepwise multiple regression was used to analyze the effect of active smoking index on blood glucose level.Results:1.There was statistical significance in the comparison of male's proportion between the three groups in different smoking states;Three groups were compared pairwise: the proportion of male in the active smoking group was higher than that in the passive smoking group and the non-smoking group,the difference was statistically significant(P < 0.01);There was no statistical significance between the passive smoking group and the non-smoking group(P > 0.05).2.Comparison among male groups2.1 There were no differences in the course of diabetes,history of hypertension,oral hypoglycemic drugs,insulin injection,oral lipid-lowering drugs,BMI,SBP,DBP,WC,HC,WHR,FCP,Lg HOMA-IR,TC,LDL-C,HDL-C,UN,Cr,UA,ALT,AST,GGT and u ACR among the male three groups(P>0.05).There were significant differences in age,family history of diabetes,drinking history,FPG,Hb A1 c,Lg HOMA-?,TG,FGF21 among the three groups;Three groups were compared pairwise: the proportion of drinking history,FPG,Hb A1 c,TG and FGF21 level in the active smoking group were higher than those in the non-smoking group,the age and Lg HOMA-? were lower than those in the non-smoking group,the proportion of family history of diabetes was higher than that in the passive smoking group,and FPG,Hb A1 c and FGF21 level in the passive smoking group were higher than those in the non-smoking group,with statistical significance(P < 0.05);There was no significant difference between the remaining groups.2.2 The active smoking index of male was positively correlated with age,Hb A1c(r= 0.499 and 0.267,P<0.05).2.3 Multiple stepwise regression analysis was used to analyze the factors affecting Hb A1 c in male active smoking group.The results showed that active smoking index was an independent factor affecting Hb A1c(R=0.637,P<0.05).3.Comparison among female groups3.1 There were no differences in the course of diabetes,family history of diabetes,history of hypertension,oral hypoglycemic drugs,insulin injection,oral lipid-lowering drugs,BMI,SBP,DBP,WC,HC,WHR,FCP,Lg HOMA-IR,TC,LDL-C,HDL-C,UN,Cr,UA,ALT,AST,GGT between the smoking group and non-smoking group(P > 0.05);The age,FPG,Hb A1 c,TG,u ACR and FGF21 levels in the passive smoking group were higher than those in the non-smoking group,The level of Lg HOMA-? in the non-smoking group was lower than that in the non-smoking group,with statistical significance(P < 0.05).3.2 Passive smoking index of female was positively correlated with age(r=0.388,P<0.05).4.Correlation analysis showed that FGF21 was positively correlated with BMI,WC,HC,WHR,FPG,Hb A1 c,FCP,Lg HOMA-IR,TG and LDL-C(r=0.378?0.351?0.235?0.218?0.288?0.261?0.164?0.234?0.325 ? 0.183,P<0.05),and negatively correlated with HDL-C(r=-0.367,P<0.05).Multiple stepwise regression analysis was used to analyze the factors affecting FGF21.The results showed that FPG?TG?HDL-C was an independent factor affecting FGF21(R=0.622,P<0.01).Conclusions:1.Both active and passive smoking in male T2 DM patients can affect glucose and lipid metabolism,increase the levels of FPG,Hb A1 c and TG.2.Passive smoking in female T2 DM patients can affect the metabolism of glucose and lipid,and may affect the occurrence of diabetic nephropathy,which can increase the levels of FPG,HBA1 c,TG and u ACR.3.Active smoking and passive smoking can increase FGF21 level in male T2 DM patients.Passive smoking can increase FGF21 level in female T2 DM patients.FPG?TG?HDL-C was an independent factor affecting FGF21,suggesting that FGF21 may be a biomarker of glucose and lipid metabolism disorder in patients with T2 DM.