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类风湿关节炎患者合并糖代谢异常的临床研究 被引量:11

Disorders of glucose metabolism in patients with rheumatoid arthritis
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摘要 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. 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.
出处 《中华风湿病学杂志》 CAS CSCD 北大核心 2014年第7期460-464,共5页 Chinese Journal of Rheumatology
关键词 关节炎 类风湿 糖尿病 2型 炎症 胰岛素抵抗 Arthritis, rheumatoid Diabetes mellitus, type 2 Inflammation Insulin resistance
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