合并类风湿关节炎的2型糖尿病患者血糖及血脂代谢特点研究

Changes of blood glucose and lipid metabolism in patients of type 2 diabetes concomitant with rheumatoid arthritis

目的 探讨合并类风湿关节炎（RA）的2型糖尿病（T2DM）患者血糖及血脂代谢的特点.方法 选择73例合并RA的T2DM患者作为观察组,不合并RA的T2DM患者60例作为对照组.2组分别检测体重指数、收缩压、舒张压、血清中三酰甘油、总胆固醇、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、空腹血糖,餐后2h血糖（PBG）、C反应蛋白（CRP）、糖化血清白蛋白（GA）及糖化血红蛋白（HbA1c）及红细胞沉降率（ESR）,比较2组患者各指标的差异.按照ESR是否升高将T2DM合并RA患者分为2组,比较各实验室指标的差异.结果 合并RA的T2DM患者血清总胆固醇为（4.3±1.0） mmol/L,明显低于不合并RA的T2DM患者（4.7±0.9） mmol/L,差异有统计学意义（P＜0.05）;合并RA的T2DM患者总胆固醇/HDL-C （4.0±1.0）明显低于不合并RA的T2DM患者（4.5±1.4）,差异有统计学意义（P＜0.05）;LDL-C水平（2.6±0.7） mmol/L与不合并RA的T2DM患者（3.0±0.4）mmol/L比较,差异有统计学意义（P＜0.01）;合并RA的T2DM患者血清CRP中位数为14.54（1.62,17.95） mg/L,明显高于不合并RA的T2DM患者2.13（0.83,4.77） mg/L（P＜ 0.01）,ESR（38±22） mm/1 h也较不合并RA的T2DM患者（16±11）mm/1 h明显升高,差异有统计学意义（P＜0.01）;2组患者体重指数、收缩压及舒张压比较差异无统计学意义,2组三酰甘油、空腹血糖、PBG、GA及HbA1c比较差异亦无统计学意义.在合并RA的T2DM患者中,ESR升高组总胆固醇/HDL-C （4.2 ± 1.0） mmol/L明显高于ESR正常组（3.7±0.8） mmol/L（P＜0.05）,ESR升高组GA水平（28±11）％明显高于ESR正常组（18±5）％（P＜0.05）,CRP水平中位数为15.52（6.47,28.67） mmol/L亦明显高于ESR正常组3.14（1.17,6.18） mmol/L（P ＜0.01）;2组空腹血糖、PBG及HbA1c比较差异无统计学意义.结论 合并RA的T2DM患者血脂水平明显低于不合并RA的T2DM患者,RA患者风湿活动使机体维持在高水平的炎症状态,导致血糖及血脂代谢紊乱,可能进一步加重T2DM患者的患心血管疾病的风险.

Objective To investigate the characteristics of blood glucose and lipid metabolism in patients of type 2 diabetes mellitus （T2DM）concomitant with rheumatoid arthritis （RA）.Methods Totally 73 patients of T2DM concomitant with RA were enrolled; T2DM patients without RA were as controls.Body mass index （BMI）,systolic blood pressure （SBP） and diastolic blood pressure （DBP） in patients of T2DM with and without RA were measured.Serum triglyceride （TG）,total cholesterol （TC）,high density lipoprotein cholesterol （HDL-C）,low density lipoprotein cholesterol （LDL-C）,fasting blood glucose （FBG）,2 h postprandial blood glucose （PBG）,C-reactive protein （CRP）,glycated albumin （GA）,glycosylated hemoglobin （HbA1 c） and erythrocyte sedimentation rate （ESR） were detected; the differences of each index between 2 groups were compared; patients of T2DM concomitant with RA were divided into abnormal ESR and normal ESR groups.Results Levels of serum TC were lower in T2DM combined with RA patients （4.3 ± 1.0） mmol/L than those of controls （4.7 ± 0.9） mmol/L（P 〈0.05） ; TC / HDL-C （4.0 ± 1.0） were lower in T2DM concomitant with RA patients （4.5 ± 1.4） （P 〈 0.05） ;LDL-C levels in patients of T2DM concomitant with RA （2.6 ± 0.7） mmol/L were significantly lower （3.0 ±0.4） mmol/L （P 〈 0.01） ; serum CRP and ESR were significantly higher in patients of T2DM concomitant with RA than those in control group 14.54 （1.62,17.95） mg/L vs 2.13 （0.83,4.77） mg/L and （38 ± 22） vs （16 ± 11） mm/1 h,respectively （all P 〈 0.01） ; BMI,SBP and DBP in patients of T2DM with and without RA did not show any differences; TG,FBG,PBG,GA and HbAlc did not show significant differences between 2 groups.In patients of T2DM concomitant with RA,TC/HDL-C were significantly higher in abnormal ESR group （4.2 ± 1.0）mmol/L （P 〈 0.05） ; GA levels were higher in abnormal ESR group（28 ± 11）% than those in normal ESR group （18 ± 5） % （P 〈 0.05） ; CRP level was significantly higher in abnormal ESR group 15.52 （6.47,28.67） mg/L than that in normal ESR group 3.14 （1.17,6.18）nmg/L（P 〈 0.01） ; FBG,PBG and HbA1c did not show any differences between 2 groups.Conclusions The levels of lipids metabolism in patients of T2DM concomitant with RA are significantly lower than those in patients of T2DM without RA ; the lipids metabolism disorders may be caused by RA itself.Elevated activity of RA disease may increase the level of inflammatory response and disorders of blood glucose and lipids metabolism,which may further aggravate the risk of cardiovascular disease in patients with T2DM.