中华内科杂志
中華內科雜誌
중화내과잡지
CHINESE JOURNAL OF INTERNAL MEDICINE
2011年
1期
18-22
,共5页
曾映娟%曾凡钦%戴冽%杨川%林宝珠%郑东辉%刘次伟%刘丹%严励%程桦
曾映娟%曾凡欽%戴冽%楊川%林寶珠%鄭東輝%劉次偉%劉丹%嚴勵%程樺
증영연%증범흠%대렬%양천%림보주%정동휘%류차위%류단%엄려%정화
红斑狼疮,系统性%胰岛素抗药性%胰岛
紅斑狼瘡,繫統性%胰島素抗藥性%胰島
홍반랑창,계통성%이도소항약성%이도
Lupus erythematosus,systemic%Insulin resistance%Islets of Langerhans
目的 分析不同糖代谢状态下女性系统性红斑狼疮(SLE)患者胰岛素敏感性和胰岛β细胞功能.方法 146例女性SLE患者分为正常糖耐量(NGT)、糖耐量减低(IGT)和糖尿病(DM)3组,分别比较其与非SLE对照组的胰岛素敏感性和胰岛β细胞功能,并分析其影响因素.结果 NGT状态,未用糖皮质激素(激素)SLE组的胰岛素敏感性和胰岛β细胞功能与正常对照组差异无统计学意义(P＞0.05),而已用激素SLE组的稳态模型评估胰岛素抵抗指数(HOMA-IR)、In(HOMA-β)、In(早相胰岛素分泌指数,EISI)和In(晚相胰岛素分泌指数,LISI)均高于未用激素SLE组和正常对照组(1.91±1.04比0.81±0.75、0.94±0.27;5.05±0.65比4.01±0.63、4.23±0.47;3.14±0.81比2.42±0.39、2.50±0.65;2.30±0.55比1.62±0.57、1.56±0.43,P值均＜0.05),In(Matsuda指数)低于后两组(4.53±0.54比5.27±0.68、5.18±0.38,P＜0.05);IGT和DM状态,已用激素SLE组的HOMA-IR(2.84±1.87比1.82±1.22;3.18±2.29比2.94±2.26)和In(HOMA-β)(5.18±0.93比4.06±0.58;3.99±1.04比3.43±0.83)均高于非SLE组(P＜0.05).回归分析显示,βMI和In(每天激素用量)为女性SLE患者胰岛素敏感性的独立危险因素;年龄、In(SLE病情活动评分)和In(每天激素用量)是女性SLE患者胰岛β细胞功能的独立影响因素.结论 NGT、IGT和DM状态,已用激素女性SLE患者均存在胰岛素敏感性降低和胰岛β细胞功能增高,这些改变均可能与激素应用有关.
目的 分析不同糖代謝狀態下女性繫統性紅斑狼瘡(SLE)患者胰島素敏感性和胰島β細胞功能.方法 146例女性SLE患者分為正常糖耐量(NGT)、糖耐量減低(IGT)和糖尿病(DM)3組,分彆比較其與非SLE對照組的胰島素敏感性和胰島β細胞功能,併分析其影響因素.結果 NGT狀態,未用糖皮質激素(激素)SLE組的胰島素敏感性和胰島β細胞功能與正常對照組差異無統計學意義(P＞0.05),而已用激素SLE組的穩態模型評估胰島素牴抗指數(HOMA-IR)、In(HOMA-β)、In(早相胰島素分泌指數,EISI)和In(晚相胰島素分泌指數,LISI)均高于未用激素SLE組和正常對照組(1.91±1.04比0.81±0.75、0.94±0.27;5.05±0.65比4.01±0.63、4.23±0.47;3.14±0.81比2.42±0.39、2.50±0.65;2.30±0.55比1.62±0.57、1.56±0.43,P值均＜0.05),In(Matsuda指數)低于後兩組(4.53±0.54比5.27±0.68、5.18±0.38,P＜0.05);IGT和DM狀態,已用激素SLE組的HOMA-IR(2.84±1.87比1.82±1.22;3.18±2.29比2.94±2.26)和In(HOMA-β)(5.18±0.93比4.06±0.58;3.99±1.04比3.43±0.83)均高于非SLE組(P＜0.05).迴歸分析顯示,βMI和In(每天激素用量)為女性SLE患者胰島素敏感性的獨立危險因素;年齡、In(SLE病情活動評分)和In(每天激素用量)是女性SLE患者胰島β細胞功能的獨立影響因素.結論 NGT、IGT和DM狀態,已用激素女性SLE患者均存在胰島素敏感性降低和胰島β細胞功能增高,這些改變均可能與激素應用有關.
목적 분석불동당대사상태하녀성계통성홍반랑창(SLE)환자이도소민감성화이도β세포공능.방법 146례녀성SLE환자분위정상당내량(NGT)、당내량감저(IGT)화당뇨병(DM)3조,분별비교기여비SLE대조조적이도소민감성화이도β세포공능,병분석기영향인소.결과 NGT상태,미용당피질격소(격소)SLE조적이도소민감성화이도β세포공능여정상대조조차이무통계학의의(P＞0.05),이이용격소SLE조적은태모형평고이도소저항지수(HOMA-IR)、In(HOMA-β)、In(조상이도소분비지수,EISI)화In(만상이도소분비지수,LISI)균고우미용격소SLE조화정상대조조(1.91±1.04비0.81±0.75、0.94±0.27;5.05±0.65비4.01±0.63、4.23±0.47;3.14±0.81비2.42±0.39、2.50±0.65;2.30±0.55비1.62±0.57、1.56±0.43,P치균＜0.05),In(Matsuda지수)저우후량조(4.53±0.54비5.27±0.68、5.18±0.38,P＜0.05);IGT화DM상태,이용격소SLE조적HOMA-IR(2.84±1.87비1.82±1.22;3.18±2.29비2.94±2.26)화In(HOMA-β)(5.18±0.93비4.06±0.58;3.99±1.04비3.43±0.83)균고우비SLE조(P＜0.05).회귀분석현시,βMI화In(매천격소용량)위녀성SLE환자이도소민감성적독립위험인소;년령、In(SLE병정활동평분)화In(매천격소용량)시녀성SLE환자이도β세포공능적독립영향인소.결론 NGT、IGT화DM상태,이용격소녀성SLE환자균존재이도소민감성강저화이도β세포공능증고,저사개변균가능여격소응용유관.
Objective To investigate insulin sensitivity and beta cell function in female systemic lupus erythematosus (SLE) patients with different glucose tolerances. Methods Insulin sensitivity and beta cell function were compared between SLE patients and non-SLE subjects in the states of normal glucose tolerance (NGT), impaired glucose tolerance (IGT)and diabetes mellitus (DM) respectively.Furthermore, risk factors for insulin sensitivity and beta cell function in SLE patients were analysed by linear regression. Results In NGT state, insulin sensitivity and beta cell function of newly diagnosed SLE patients without glucocorticoids treatment were not significantly different from those of normal control group ( P ＜0. 05). Compared with newly diagnosed SLE patients without glucocorticoids treatment and normal control group, HOMA insulin resistance index (HOMA-IR) , In (HOMA-β), In (early phase insulin secretion index, EISI ) and In ( late phase insulin secretion index, LISI ) of SLE patients with glucocorticoids treatment were significantly higher( 1.91 ± 1.04 vs 0. 81 ±0. 75,0. 94 ±0. 27;5.05 ±0. 65 vs 4. 01 ±0. 63,4. 23 ±0.47;3. 14±0.81 vs 2.42 ±0.39,2.50±0.65;2.30 ±0.55 vs 1.62 ±0.57,1.56 ±0.43;P ＜0.05),while In ( Matsuda index, MI ) was significantly lower ( 4. 53 ± 0. 54 vs 5. 27 ± 0. 68,5. 18 ± 0. 38; P ＜0. 05). In IGT and DM state, HOMA-IR (2. 84 ± 1. 87 vs 1.82 ± 1.22, 3. 18 ±2. 29 vs 2. 94 ±2. 26) and In (HOMA-β) (5. 18 ±0. 93 vs 4. 06 ±0. 58, 3. 99 ± 1.04 vs 3.43 ±0. 83) were significantly higher in SLE patients with glucocorticoids treatment than those of non-SLE subjects ( P ＜ 0. 05 ) respectively. BMI and In (daily glucocorticords doses) were independent risk factors for insulin sensitivity, and age, the SLE disease activity index(SLEDAI) and In(daily glucocorticords doses) were related factors beta cell function.Conclusion In NGT, IGT and DM state,SLE female patients with glucocorticoids treatment have reduced insulin sensitivity and increased beta cell function, these changes are related to the use of glucocorticoids.
