中华风湿病学杂志
中華風濕病學雜誌
중화풍습병학잡지
CHINESE JOURNAL OF RHEUMATOLOGY
2014年
7期
460-464
,共5页
吕晓虹%冯秀媛%蒲丹%孙怡宁%周文旭%何岚
呂曉虹%馮秀媛%蒲丹%孫怡寧%週文旭%何嵐
려효홍%풍수원%포단%손이저%주문욱%하람
关节炎,类风湿%糖尿病,2型%炎症%胰岛素抵抗
關節炎,類風濕%糖尿病,2型%炎癥%胰島素牴抗
관절염,류풍습%당뇨병,2형%염증%이도소저항
Arthritis,rheumatoid%Diabetes mellitus,type 2%Inflammation%Insulin resistance
目的 探讨RA患者合并糖代谢异常、胰岛素抵抗(IR)状况及其与RA病情活动性的关系.方法 以RA患者123例,健康体检人员98名为研究对象,行75 g口服葡萄糖耐量试验,计算稳态模型胰岛素抵抗指数(HOMA-IR)、胰岛素分泌指数(HOMA-β),比较2组间2型糖尿病(T2DM)、糖尿病前期患病率以及HOMA-IR、HOMA-β等指标;RA患者根据有无合并糖代谢异常分为糖代谢异常组(包括T2DM、糖尿病前期)和正常血糖组,比较2组间RA病情活动指标;根据DAS28评分分为疾病高度活动、低中度活动组,比较2组间糖代谢指标、HOMA-IR、HOMA-β等并行相关性分析.采用t检验,Pearson相关分析及x2检验对资料进行统计学分析.结果 RA患者T2DM、糖尿病前期患病率均高于对照组[分别为20.3％(25/123)与5.1％(5/98),39.0％(48/123)与7.1％(7/98); x2=10.774,29.657,P均＜0.01];RA患者HOMA-IR高于对照组(2.5±1.5与0.8±0.4;t=5.185,P＜0.01),HOMA-β低于对照组(83±69与192±85;t=3.768,P＜0.01).RA合并糖代谢异常组ESR[分别为(55±30),(37±26) mm/1 h;t=3.159,P＜0.01]、CRP[分别为(40±23),(19±10) mg/L;t=3.628,P＜0.01]、DAS28评分(5.6±1.3与4.8±1.2;t=2.923,P＜0.01)高于RA血糖正常组.RA病情高度活动(DAS28＞5.5)组空腹胰岛素水平[分别为(9±5),(5±4) mU/L; t=0.892,P＜0.01]、HOMA-IR值(分别为2.8±0.5,1.2±0.3;t=0.439,P＜0.01)高于病情低、中度活动(DAS28≤5.5)组.RA患者HOMA-IR值与DAS28活动性评分、CRP、ESR呈正相关(r分别为0.39,0.20,0.54,P＜0.01或P＜0.05).结论 RA患者存在IR,胰岛β细胞功能受损,其T2DM、糖尿病前期患病率较对照人群升高.RA糖代谢异常的发生及IR程度与病情活动性、炎症状态相关.
目的 探討RA患者閤併糖代謝異常、胰島素牴抗(IR)狀況及其與RA病情活動性的關繫.方法 以RA患者123例,健康體檢人員98名為研究對象,行75 g口服葡萄糖耐量試驗,計算穩態模型胰島素牴抗指數(HOMA-IR)、胰島素分泌指數(HOMA-β),比較2組間2型糖尿病(T2DM)、糖尿病前期患病率以及HOMA-IR、HOMA-β等指標;RA患者根據有無閤併糖代謝異常分為糖代謝異常組(包括T2DM、糖尿病前期)和正常血糖組,比較2組間RA病情活動指標;根據DAS28評分分為疾病高度活動、低中度活動組,比較2組間糖代謝指標、HOMA-IR、HOMA-β等併行相關性分析.採用t檢驗,Pearson相關分析及x2檢驗對資料進行統計學分析.結果 RA患者T2DM、糖尿病前期患病率均高于對照組[分彆為20.3％(25/123)與5.1％(5/98),39.0％(48/123)與7.1％(7/98); x2=10.774,29.657,P均＜0.01];RA患者HOMA-IR高于對照組(2.5±1.5與0.8±0.4;t=5.185,P＜0.01),HOMA-β低于對照組(83±69與192±85;t=3.768,P＜0.01).RA閤併糖代謝異常組ESR[分彆為(55±30),(37±26) mm/1 h;t=3.159,P＜0.01]、CRP[分彆為(40±23),(19±10) mg/L;t=3.628,P＜0.01]、DAS28評分(5.6±1.3與4.8±1.2;t=2.923,P＜0.01)高于RA血糖正常組.RA病情高度活動(DAS28＞5.5)組空腹胰島素水平[分彆為(9±5),(5±4) mU/L; t=0.892,P＜0.01]、HOMA-IR值(分彆為2.8±0.5,1.2±0.3;t=0.439,P＜0.01)高于病情低、中度活動(DAS28≤5.5)組.RA患者HOMA-IR值與DAS28活動性評分、CRP、ESR呈正相關(r分彆為0.39,0.20,0.54,P＜0.01或P＜0.05).結論 RA患者存在IR,胰島β細胞功能受損,其T2DM、糖尿病前期患病率較對照人群升高.RA糖代謝異常的髮生及IR程度與病情活動性、炎癥狀態相關.
목적 탐토RA환자합병당대사이상、이도소저항(IR)상황급기여RA병정활동성적관계.방법 이RA환자123례,건강체검인원98명위연구대상,행75 g구복포도당내량시험,계산은태모형이도소저항지수(HOMA-IR)、이도소분비지수(HOMA-β),비교2조간2형당뇨병(T2DM)、당뇨병전기환병솔이급HOMA-IR、HOMA-β등지표;RA환자근거유무합병당대사이상분위당대사이상조(포괄T2DM、당뇨병전기)화정상혈당조,비교2조간RA병정활동지표;근거DAS28평분분위질병고도활동、저중도활동조,비교2조간당대사지표、HOMA-IR、HOMA-β등병행상관성분석.채용t검험,Pearson상관분석급x2검험대자료진행통계학분석.결과 RA환자T2DM、당뇨병전기환병솔균고우대조조[분별위20.3％(25/123)여5.1％(5/98),39.0％(48/123)여7.1％(7/98); x2=10.774,29.657,P균＜0.01];RA환자HOMA-IR고우대조조(2.5±1.5여0.8±0.4;t=5.185,P＜0.01),HOMA-β저우대조조(83±69여192±85;t=3.768,P＜0.01).RA합병당대사이상조ESR[분별위(55±30),(37±26) mm/1 h;t=3.159,P＜0.01]、CRP[분별위(40±23),(19±10) mg/L;t=3.628,P＜0.01]、DAS28평분(5.6±1.3여4.8±1.2;t=2.923,P＜0.01)고우RA혈당정상조.RA병정고도활동(DAS28＞5.5)조공복이도소수평[분별위(9±5),(5±4) mU/L; t=0.892,P＜0.01]、HOMA-IR치(분별위2.8±0.5,1.2±0.3;t=0.439,P＜0.01)고우병정저、중도활동(DAS28≤5.5)조.RA환자HOMA-IR치여DAS28활동성평분、CRP、ESR정정상관(r분별위0.39,0.20,0.54,P＜0.01혹P＜0.05).결론 RA환자존재IR,이도β세포공능수손,기T2DM、당뇨병전기환병솔교대조인군승고.RA당대사이상적발생급IR정도여병정활동성、염증상태상관.
Objective To assess the disorders of glucose metabolism and insulin resistance in patients with rheumatoid arthritis (RA) and its relationship with disease activity.Methods One hundred and twenty-three RA patients along with 98 age and sex matched controls were studied.Seventy-five g oral glucose tolerance test was performed.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,patients were divided into high disease activity group and low to moderate disease activity group.Glucose tolerance and HOMA-IR were compared between the two groups.Parameters that reflects disease activity,such as CRP and ESR,as well as disease activity scores were compared between patients with T2DM or prediabetes and patients with normal glucose tolerance.The data was analyzed by t test,Pearson correlation analysis and chi-square test.Results The prevalence of T2DM [20.3％(25/123) vs 5.1％ (5/98),x2=10.774,P＜0.01] and prediabetes [39.0％ (48/123) vs 7.1％ (7/98),x2=29.657,P＜0.01] increased in RA patients compared to controls.RA patients had higher HOMA-IR (2.5±1.5 vs 0.8±0.4; t=5.185,P＜0.01) and lower HOMA-β (83±69 vs 192±85; t=3.768,P＜0.01) compared to controls.ESR [(55±30) mm/1 h vs (37±26) mm/1 h; t=3.159,P＜0.01],CRP [(40±23) mg/L vs (19±10) mg/L; t=3.628,P＜0.01] and DAS28 score (5.6±1.3 vs 4.8±1.2; t=2.923,P＜0.01) were higher in RA patients with T2DM or prediabetes than in RA patients with normal glucose tolerance.In RA patients,the HOMA-IR was significantly positively correlated with DAS28 (r=0.39,P＜0.01),ESR (r=0.54,P＜0.01)and CRP (r=0.20,P＜0.05).The HOMA-IR value and fasting insulin levels were higher in high disease activity patients (DAS28＞ 5.5) than in low-to-moderate disease activity patients (DAS28 ≤5.5) although fasting plasma glucose level did not differ significantly in these two groups.Conclusion The prevalence of T2DM and prediabetes increases in RA patients comparing to controls.RA patients have insulin resistance that is associated with disease activity and systemic inflammation.
