重症多形红斑/中毒性表皮坏死松解症患者脂肪细胞因子测定的临床意义及其与胰岛素抵抗的关系

Clinical significance of determination of adipocytokines in patients with Stevens-Johnson syndrome/toxic epidermal necrolysis and its relationship with insulin resistance

目的分析重症多形红斑/中毒性表皮坏死松解症(SJS/TEN)患者血清中瘦素、可溶性瘦素受体、脂联素测定的临床意义及其与胰岛素抵抗的关系。方法自2019年1—12月共收集杭州市第三人民医院皮肤科、内分泌科门诊及住院患者120例,按前瞻性队列研究分为四组,正常组57例、2型糖尿病(T2DM)组46例、SJS/TEN伴发类固醇糖尿病患者(SDM)组8例、SJS/TEN组9例,观察并记录四组人群的基本资料,计算相应的体重指数(BMI)并比较组间差异;比较四组人群的胰岛素抵抗指数,并分析其差异性;测定四组人群的血清瘦素、瘦素受体和脂联素水平,并分析其相关性;分析SJS/TEN伴发SDM患者血清瘦素、瘦素受体和脂联素水平与胰岛素抵抗的关系。结果SJS/TEN伴发SDM组BMI与正常组比较,差异有统计学意义(P<0.05)。SJS/TEN伴发SDM组和T2DM组的胰岛素抵抗指数均明显高于正常组(P<0.01),与T2DM组比较,SJS/TEN伴发SDM组和SJS/TEN组患者的胰岛素抵抗指数差异有统计学意义(P<0.05)。SJS/TEN伴发SDM组患者和SJS/TEN组患者的血清中瘦素水平与T2DM组及正常组差异无统计学意义(P>0.05),但瘦素受体水平均明显低于正常组和T2DM组(P<0.01),SJS/TEN组患者的脂联素水平低于T2DM组(P<0.05),但与正常组比较差异无统计学意义(P>0.05)。胰岛素抵抗指数与SJS/TEN伴发SDM组患者的瘦素、瘦素受体和脂联素水平均呈明显负相关。结论证实SJS/TEN与代谢性疾病具有相关性,胰岛素抵抗可能是SJS/TEN伴发代谢性疾病的病理生理基础,并且这些细胞因子可能与SJS/TEN伴发代谢性疾病有关。

Objective To analyze the clinical significance of determining serum leptin,soluble leptin receptor,and adiponectin in patients with Stevens-Johnson syndrome/toxic epidermal necrolysis(SJS/TEN)and their relationship with insulin resistance.Methods From January to December 2019,a total of 120 outpatients and inpatients from the Department of Dermatology and Endocrinology of Third People's Hospital of Hangzhou were collected.They were divided into four groups according to prospective cohort study.There were 57 patients in the normal group,46 in the type 2 diabetes mellitus(T2DM)group,8 in the group of SJS/TEN with SJS/TEN with steroid diabetes(SDM),and 9 in the group of SJS/TEN alone.The basic data of the four groups of people was observed and recorded,the corresponding BMI values were calculated and the differences between the groups were compared.The insulin resistance indexes of the four groups of people were compared,and their differences were analyzed.The levels of serum leptin,leptin receptor and adiponectin in the four groups were determined,and their correlations were analyzed.The relationships between serum leptin,leptin receptor and adiponectin levels and insulin resistance in SJS/TEN patients with SDM were also analyzed.Results There was statistically significantly difference in the body mass index(BMI)of patients in the SJS/TEN with SDM group and those in the normal group(P<0.05).The insulin resistance indexes of patients in the SJS/TEN with SDM group and T2DM group were significantly higher than those in the normal group(P<0.01).Compared with the T2DM group,the insulin resistance indexes of patients in the SJS/TEN with SDM group and the SJS/TEN without SDM group was also significantly different(P<0.05).There were no significant differences in serum leptin levels of the SJS/TEN with SDM group and the SJS/TEN without SDM group compared with the T2DM group and the normal group(P>0.05),but the levels of leptin receptors in patients of these two groups were significantly lower than those in the normal group and the T2DM group(P<0.01).The levels of adiponectin in patients of the SJS/TEN without SDM group were lower than those in the T2DM group(P<0.05),but there was no statistically significant difference compared with the normal group(P>0.05).The insulin resistance index was significantly negatively correlated with the levels of leptin,leptin receptor and adiponectin in SJS/TEN patients with SDM.Conclusion It is confirmed that SJS/TEN is related to metabolic diseases,insulin resistance may be the pathophysiological basis of SJS/TEN with metabolic diseases,and these cytokines may be related to SJS/TEN with me tabolic diseases.