类风湿关节炎及抗风湿药物对胰岛素抵抗及2型糖尿病的影响研究进展

Effects of rheumatoid arthritis and antirheumatic drugs on insulin resistance and type 2 diabetes mellitus

类风湿关节炎(RA)患者合并胰岛素抵抗(IR)和2型糖尿病的比例显著高于非RA人群,并与心血管事件的发生及预后密切相关。RA多种促炎细胞因子和炎症指标如肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、IL-1、脂肪因子和C反应蛋白的异常,对RA患者糖代谢紊乱产生重要影响。抗风湿药物对RA患者的IR产生影响,糖皮质激素导致的血糖升高以餐后血糖升高为主,甲氨蝶呤、硫酸羟氯喹可增加胰岛素的敏感性而改善IR,并减少2型糖尿病的发病风险,生物制剂TNF-α抑制剂、IL-6受体拮抗剂和IL-1β受体拮抗剂治疗,已被证实可以改善IR。临床上应重视RA患者血糖及糖化血红蛋白的监测,积极控制RA疾病活动对于改善IR及预防心血管并发症具有重要意义。

Patients with rheumatoid arthritis （RA） have high prevalence rates of insulin resistance （IR） and type 2 diabetes mellitus （T2 DM）, which are closely related to occurrence of adverse cardiovascular events and poor prognosis. Proinflammatory cytokines and inflammatory mediators such as tumor necrosis factor-α （TNF-α）, interleukin-6（IL-6）, interleukin-1 （IL-1）, adipokine and C-reactive protein（CRP） play key roles in glycometabolism disorders of RA patients. Antirheumatic drugs have effects on IR in RA patients; glucocorticoids can canse postprandial hyperglycemia; methotrexate and hydroxychloroquine sulfate may increase insulin sensitivity and reduce the risk of T2DM; biological agents such as TNF-α inhibitor, IL-6 receptor antagonist and IL-I[3 receptor antagonist have been proved to alleviate IR. It is recommended that regular blood glucose, glycosylated hemoglobin monitoring and positive control of disease activity in RA patients can improve IR and prevent cardiovascular complications.