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  

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

作　　者：靳永欣 徐萍[1] 高彦青 刘铮[1] 朱桂晋 赵冕 周蕾[1] 

机构地区：[1]天津医科大学总医院风湿免疫科,300052

出　　处：《天津医药》2017年第12期1282-1285,共4页Tianjin Medical Journal

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。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

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 

分 类 号：R593.241[医药卫生—内科学]