天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (12): 1282-1285.doi: 10.11958/20170866

• 临床研究 • 上一篇    下一篇

系统性红斑狼疮患者胰岛素抵抗情况及其与 糖皮质激素的关系

靳永欣， 徐萍， 高彦青， 刘铮， 朱桂晋， 赵冕， 周蕾△   

  1. 作者单位： 天津医科大学总医院风湿免疫科 （邮编 300052） 作者简介： 靳永欣 （1992）， 女， 硕士在读， 主要从事风湿病学相关研究 △通讯作者 E-mail：yizhe1234@126.com
  • 收稿日期:2017-08-04 修回日期:2017-11-09 出版日期:2017-12-15 发布日期:2017-12-15
  • 通讯作者: 靳永欣 E-mail:jinyx0212@163.com

The relationship between insulin resistance and glucocorticoids in patients with systemic lupus erythematosus

JIN Yong-xin, XU Ping, GAO Yan-qing, LIU Zheng, ZHU Gui-jin, ZHAO Mian, ZHOU Lei△   

  1. Department of Rheumatology and Immunology, Tianjin Medical University, Tianjin 300052, China △Corresponding Author E-mail: yizhe1234@126.com
  • Received:2017-08-04 Revised:2017-11-09 Published:2017-12-15 Online:2017-12-15

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摘要： 目的 评价系统性红斑狼疮 （SLE） 患者合并胰岛素抵抗 （IR） 的情况， 探讨糖皮质激素对 IR 的影响及临床 意义。方法 选取 2013 年 5 月—2017 年 5 月就诊于天津医科大学总医院风湿免疫科的 SLE 患者（SLE 组） 301 例 和健康志愿者 （正常对照组） 103 例为研究对象， 利用稳态模型 （HOMA） 评估胰岛素抵抗指数 （HOMA-IR）、 HOMA-β 细胞功能指数（HBCI）和胰岛素敏感指数（ISI）， 以 103 例健康志愿者 HOMA-IR 指数分布的上 1/4 位点值为切点确 定 IR 分组， 依据近 3 个月糖皮质激素使用剂量将 SLE 组分为糖皮质激素＞7.5 mg/d 组、 糖皮质激素≤7.5 mg/d 组、 未 用糖皮质激素组， 分别比较各组间上述指标的差异， 并应用直线相关分析其与 HOMA-IR 的相关性。结果 与正常 对照组相比， SLE 组三酰甘油、 空腹胰岛素、 HOMA-IR、 HOMA-HBCI 升高 （P＜0.05）， 高密度脂蛋白胆固醇、 ISI 降低 （P＜0.01）， 但不同剂量糖皮质激素组间三酰甘油、 空腹胰岛素、 HOMA-IR、 ISI 差异均无统计学意义（P＞0.05）。应 用糖皮质激素的 2 组 SLE 患者 HOMA-HBCI 高于未用糖皮质激素组及正常对照组 （P＜0.05）， 未用糖皮质激素组与 正常对照组间差异无统计学意义（P＞0.05）。SLE 组 HOMA-IR 与空腹血糖（r=0.566）、 空腹胰岛素（r=0.949）、 HOMA-HBCI（r=0.280）呈正相关（均 P＜0.01）， 与三酰甘油（r=-0.139）、 ISI（r=-0.896）呈负相关（均 P＜0.01）。结论 SLE 患者体内存在胰岛素分泌异常且 IR 的发生率升高， 长时间糖皮质激素治疗可能参与其 IR 的形成。

关键词: 红斑狼疮, 系统性, 胰岛素抵抗, 胰岛 β 细胞, 胰岛素, 糖皮质激素

Abstract: Objective To evaluate insulin resistance (IR) in patients with systemic lupus erythematosus (SLE) and investigate the effect of glucocorticoids on IR and its clinical significance. Methods Three hundred and one SLE patients and 103 healthy volunteers hospitalized in our hospital from May 2013 to May 2017 were included in this study. Homeostasis model assessment (HOMA) was used to calculate insulin resistance index (HOMA-IR), HOMA-β cell function index (HBCI) and insulin sensitivity index (ISI). The IR grouping was determined by using the upper 1/4 of the HOMA-IR index of 103 healthy volunteers as the cut point. According to the dose of glucocorticoids in the last 3 months, the SLE group was divided into glucocorticoids＞7.5 mg/d group, ≤7.5 mg/d group and without glucocorticoids group. These parameters were compared with all groups respectively. Furthermore, related factors for HOMA-IR were analyzed by linear correlation. Results Compared with control group, triacylglycerol (TG, P＜0.01), fasting insulin (FINS, P＜0.01), HOMA-IR (P＜0.01), HOMAHBCI (P＜0.05) were significantly increased and high-density lipoprotein cholesterol (HDL-C, P＜0.01) and ISI (P＜0.01) were significantly lower in SLE group. However, there were no significant differences in TG, FINS, HOMA-IR and ISI between different doses of glucocorticoid groups (P＞0.05). The level of HOMA-HBCI was significantly higher in two groups with glucocorticoids than that without glucocorticoid group and normal control group (P＜0.05), while there was no significant difference in HOMA-HBCI between without glucocorticoid group and the normal control group (P＞0.05). HOMA-IR was positively correlated with fasting blood glucose (FBG, r=0.566, P＜0.01), FINS (r=0.949, P＜0.01) and HOMA-HBCI (r=0.280, P＜0.01). But there was a negative correlation between TG (r=-0.139, P＜0.01) and ISI (r=-0.896, P＜0.01). Conclusion Insulin secretion is abnormal and the incidence of IR is elevated in SLE patients. Long term glucocorticoid therapy may be involved in the formation of IR.

Key words: lupus erythematosus, systemic, insulin resistance, islet β-cell function, insulin, glucocorticoids