类风湿关节炎患者胰岛素抵抗状况的评价  

Insulin resistance in patients with rheumatoid arthritis

作　　者：吕晓虹[1] 何岚[1] 施秉银[2] 蒲丹[1] 孙怡宁[1] 周文旭[1] 薛晓荣[3] 

机构地区：[1]西安交通大学医学院第一附属医院免疫风湿科,陕西西安710061 [2]西安交通大学医学院第一附属医院内分泌科,陕西西安710061 [3]西安交通大学医学院第一附属医院西安康成体检中心,陕西西安710068

出　　处：《西安交通大学学报（医学版）》2011年第1期89-92,共4页Journal of Xi’an Jiaotong University（Medical Sciences）

摘　　要：目的探讨类风湿关节炎(RA)患者胰岛素抵抗情况及其与RA病情活动性的关系。方法以我院住院RA患者50例、健康查体人员50例为研究对象,测定空腹血糖及胰岛素水平,计算稳态模型胰岛素抵抗指数(HOMA-IR)、β细胞功能指数(HOMA-β),进行两组间比较。RA患者根据疾病活动性评分(DAS28)分为疾病高度活动、低中度活动组,比较两组间HOMA-IR并行相关性分析。结果 RA患者与健康对照比较,空腹血糖、HOMA-β无统计学差异;空腹胰岛素水平[(5.60±1.57)mu/Lvs.(3.81±0.96)mu/L,P<0.05]和HOMA-IR高于健康对照(1.43±0.77vs.0.82±0.22,P<0.01)。RA患者HOMA-IR值与DAS28活动性评分正相关(r=0.42,P<0.01),与超敏C反应蛋白正相关(r=0.45,P<0.01),与体重指数无显著相关性。病情高度活动(DAS28>5.5)组和病情低、中度活动组(DAS28≤5.5)空腹血糖无统计学差异;病情高度活动组空腹胰岛素水平[(6.71±0.71)mu/Lvs.(4.80±0.33)mu/L,P<0.05]、HOMA-IR值(2.89±0.49vs.1.18±0.10,P<0.01)高于病情低、中度活动组。结论 RA患者体内存在胰岛素抵抗,其程度与RA病情活动性、炎症状态相关。Objective To assess insulin resistance in patients with rheumatoid arthritis（RA） and its relationship with disease activity.Methods Fifty RA patients admitted in our hospital along with another 50 age-and sex-matched controls for health check-up were studied.Plasma levels of fasting glucose and insulin were measured.The homeostasis model assessment of insulin resistance（HOMA-IR） and beta cell function（HOMA-β） were evaluated.Disease activity score（DAS28） was used to assess disease activity.According to their DAS28 values,the patients were divided into high disease activity group and low-to-moderate disease activity group.HOMA-IR was compared between the two groups and correlation analysis was made.Results There were no differences in fasting plasma glucose and HOMA-β between RA patients and healthy controls.RA patients had higher fasting insulin levels [（5.60±1.57）mu/L vs.（3.81±0.96）mu/ L,P0.05] and HOMA-IR（1.43±0.77 vs.0.82±0.22,P0.01） compared to those of controls.In RA patients,HOMA-IR was significantly positively correlated with DAS28（r=0.42,P0.01） and high-sensitivity C-reactive protein（r=0.45,P0.01）,but not with body mass index.Fasting plasma glucose level did not differ significantly between high disease activity patients（DAS285.5） and low-to-moderate disease activity patients（DAS28≤5.5）.High disease activity patients had higher fasting insulin levels [（6.71±0.71）mu/L vs.（4.80±0.33）mu/L,P0.05] and HOMA-IR value（2.89±0.49 vs.1.18±0.10,P0.01） than low-to-moderate disease activity patients.Conclusion RA patients show insulin resistance,which is associated with disease activity and systemic inflammation.

关 键 词：类风湿关节炎 胰岛素抵抗 血糖 DAS28评分 炎症 β细胞功能指数 

分 类 号：R593.22[医药卫生—内科学]