Svenson K L, Pollare T, Lithell H, Hällgren R
Department of Internal Medicine, University Hospital, Uppsala, Sweden.
Metabolism. 1988 Feb;37(2):125-30. doi: 10.1016/s0026-0495(98)90005-1.
Glucose metabolism was studied after an intravenous glucose loading in normal-weighted, previously untreated patients (n = 14) with active rheumatoid arthritis (RA). The patients displayed an enhanced insulin response and impaired glucose handling compared with healthy controls (P less than .001). The insulin sensitivity, measured as the glucose utilization rate during steady state of euglycemia (M) was significantly decreased (P less than .01) among the patients compared to the controls (5.5 +/- 1.9 mg/kg BW/min [mean +/- SD] and 7.2 +/- 1.2, respectively). The corresponding values for the metabolic clearance rate (MCR) were 5.8 +/- 0.6 mL/kg BW/min and 8.2 +/- 0.4, respectively (P less than .01). In the patient group the k value correlated with the peripheral insulin sensitivity (P less than .01), which, in turn, was inversely related to the acute phase reaction (P less than .05). During 1 week of potent anti-inflammatory treatment with corticosteroids (prednisolone 20 mg daily) the k value improved P less than .001), the insulin sensitivity tended to improve and the insulin response increased (P less than .001) after an intravenous glucose loading. Five patients who had a remission of their disease on sulphasalazine as antirheumatic therapy were reexamined. A normalization of the inflammatory activity as well as the glucose handling and insulin sensitivity was achieved. The data obtained indicate that impaired glucose handling in active RA is related to insulin resistance. The linkage between inflammatory indices and glucose metabolism might reflect a special consequence of inflammation, but the influence of nonspecific disease manifestations, ie, malnutrition, inactivity, and myopenia, has to be considered.
对体重正常、未经治疗的活动性类风湿关节炎（RA）患者（n = 14）静脉注射葡萄糖负荷后进行葡萄糖代谢研究。与健康对照组相比，这些患者表现出胰岛素反应增强和葡萄糖处理受损（P <.001）。以正常血糖稳态期间的葡萄糖利用率（M）衡量的胰岛素敏感性，患者组显著低于对照组（P <.01）（分别为5.5±1.9 mg/kg体重/分钟[均值±标准差]和7.2±1.2）。代谢清除率（MCR）的相应值分别为5.8±0.6 mL/kg体重/分钟和8.2±0.4（P <.01）。在患者组中，k值与外周胰岛素敏感性相关（P <.01），而外周胰岛素敏感性又与急性期反应呈负相关（P <.05）。在用皮质类固醇进行1周的强效抗炎治疗（每日泼尼松龙20 mg）期间，静脉注射葡萄糖负荷后，k值改善（P <.001），胰岛素敏感性趋于改善，胰岛素反应增加（P <.001）。对5例使用柳氮磺胺吡啶作为抗风湿治疗后病情缓解的患者进行了复查。炎症活动以及葡萄糖处理和胰岛素敏感性均恢复正常。所获得的数据表明，活动性RA中葡萄糖处理受损与胰岛素抵抗有关。炎症指标与葡萄糖代谢之间的联系可能反映了炎症的一种特殊后果，但必须考虑非特异性疾病表现（即营养不良、缺乏活动和肌肉减少症）的影响。
