Sada Ken-Ei, Yamasaki Yasushi, Maruyama Mie, Sugiyama Hitoshi, Yamamura Masahiro, Maeshima Yohei, Makino Hirofumi
Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
J Rheumatol. 2006 Aug;33(8):1545-52.
The metabolic syndrome, closely associated with cardiovascular disease, is characterized by increased insulin resistance (IR). Although accelerated atherosclerosis is frequently observed in systemic lupus erythematosus (SLE), the prevalence and significance of IR remain to be elucidated. We evaluated IR in association with plasma concentrations of adipocytokines in patients with SLE.
Outpatients with SLE (n = 37) and healthy controls (n = 80) were studied. A value of the homeostasis model assessment index (HOMA-IR) > 2.0 was considered to be IR. Plasma concentrations of adiponectin and tumor necrosis factor-a (TNF-a) were measured by ELISA and leptin by radioimmunoassay.
HOMA-IR indices of the SLE patients were significantly higher than those of controls (2.3 +/- 2.3 vs 1.3 +/- 1.0, respectively; p < 0.01), although both groups exhibited a similar body mass index. The prevalence of hypertension and diabetes mellitus was significantly higher in patients with SLE compared with controls (48.6% vs 8.8% and 10.8% vs 0%). Twelve SLE patients (32%) with IR exhibited significantly higher incidence of hypertension and current proteinuria than SLE patients without IR. Plasma leptin, TNF-a, and, unexpectedly, adiponectin levels were higher in SLE patients than controls (adiponectin, 13.7 +/- 5.0 vs 9.5 +/- 3.9 microg/ml). Among the SLE patients, patients with IR showed significantly lower adiponectin levels than patients without IR (10.9 +/- 4.6 vs 15.4 +/- 4.4 microg/ml). Serum levels of adiponectin were significantly correlated inversely with HOMA-IR in SLE patients.
Elevated levels of adiponectin in SLE, despite inverse correlation with IR, suggest the possible involvement of adiponectin in IR and alterations in its effect on insulin sensitivity.
代谢综合征与心血管疾病密切相关，其特征为胰岛素抵抗（IR）增加。虽然系统性红斑狼疮（SLE）患者常出现动脉粥样硬化加速，但IR的患病率及意义仍有待阐明。我们评估了SLE患者中IR与脂肪细胞因子血浆浓度的关系。
对SLE门诊患者（n = 37）和健康对照者（n = 80）进行研究。稳态模型评估指数（HOMA-IR）>2.0被视为IR。采用酶联免疫吸附测定法（ELISA）检测脂联素和肿瘤坏死因子-α（TNF-α）的血浆浓度，采用放射免疫测定法检测瘦素。
SLE患者的HOMA-IR指数显著高于对照组（分别为2.3±2.3和1.3±1.0；p<0.01），尽管两组的体重指数相似。与对照组相比，SLE患者高血压和糖尿病的患病率显著更高（分别为48.6%对8.8%和10.8%对0%）。12例（32%）有IR的SLE患者高血压和当前蛋白尿的发生率显著高于无IR的SLE患者。SLE患者的血浆瘦素、TNF-α水平，以及出乎意料的脂联素水平均高于对照组（脂联素：13.7±5.0对9.5±3.9μg/ml）。在SLE患者中，有IR的患者脂联素水平显著低于无IR的患者（10.9±4.6对15.4±4.4μg/ml）。SLE患者血清脂联素水平与HOMA-IR呈显著负相关。
SLE患者脂联素水平升高，尽管与IR呈负相关，但提示脂联素可能参与IR及其对胰岛素敏感性影响的改变。
