Rheumatology and Immunology Department, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China.
Rheumatology and Immunology Department, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China.
Joint Bone Spine. 2019 May;86(3):335-341. doi: 10.1016/j.jbspin.2018.07.002. Epub 2018 Jul 17.
Retinol-binding protein 4 (RBP4), systemic inflammation and insulin resistance (IR) are linked, yet the determinants of RBP4 and its impact on IR in rheumatoid arthritis (RA) are incompletely understood. The aim of this study was to explore the prevalence of IR in RA and investigate whether the serum levels of RBP4 were associated with IR in patients with RA.
In this study, 403 individuals with newly diagnosed and untreated RA were consecutively recruited. We calculated the Disease Activity Score assessed using 28-joint counts for swelling and tenderness (DAS28). Levels of serum RBP4, interleukin-6 (IL-6) and tumor necrosis factor (TNF) α were tested. IR was defined as Homeostasis model assessment for insulin resistance (HOMA-IR) index greater than or equal 2.40.
In those 403 patients, 68 (16.9%) were male and the median age was 43 years (IQR: 36-52). There was an evidently positive correlation between increased serum levels of RBP4 and increasing severity of RA (DAS28) (r = 0.403, P < 0.001). Furthermore, a modest positive correlation between levels of serum RBP4 and HOMA-IR score (r = 0.251; P < 0.0001) was found. Eighty-five patients (21.1%) in patients with RA were defined as IR (HOMA-IR ≥ 2.40), which was significantly higher than in normal cases (4.7%). In the patients with IR, serum levels of RBP4 were higher when compared with those in patients free-IR P < 0.001. The IR distribution across the quartiles of RBP4 ranged between 5.0% (first quartile) to 39.0% (fourth quartile), P for trend < 0.001. For each 1unit increase of RBP4, the unadjusted and adjusted risk of IR increased by 8% (OR: 1.08; 95% CI: 1.05-1.11, P < 0.001) and 5% (1.05; 1.02-1.09, P = 0.001), respectively. When RBP4 was added to the model containing established significant risk factors, AUROC (standard error) was increased from 0.768 (0.025) to 0.807(0.021). A significant difference in the AUC between the established risk factors alone and the addition of RBP4 was observed (difference, 0.039[0.004]; P = 0.02).
Elevated serum levels of RBP4 were associated with increased risk of IR and might be useful in identifying RA at risk for IR and/or impaired glucose tolerance for early prevention strategies, especially in obese and women patients.
视黄醇结合蛋白 4（RBP4）、全身炎症和胰岛素抵抗（IR）之间存在关联，但 RBP4 的决定因素及其对类风湿关节炎（RA）中 IR 的影响尚不完全清楚。本研究旨在探讨 RA 中 IR 的患病率，并研究血清 RBP4 水平是否与 RA 患者的 IR 相关。
本研究连续纳入了 403 名新诊断和未经治疗的 RA 患者。我们计算了使用 28 个关节肿胀和压痛评估的疾病活动评分（DAS28）。检测了血清 RBP4、白细胞介素-6（IL-6）和肿瘤坏死因子（TNF）α的水平。IR 定义为稳态模型评估的胰岛素抵抗指数（HOMA-IR）大于或等于 2.40。
在这 403 名患者中，68 名（16.9%）为男性，中位年龄为 43 岁（IQR：36-52）。血清 RBP4 水平的升高与 RA 严重程度的增加（DAS28）呈明显正相关（r=0.403，P<0.001）。此外，还发现血清 RBP4 水平与 HOMA-IR 评分之间存在适度正相关（r=0.251；P<0.0001）。85 名（21.1%）RA 患者被定义为 IR（HOMA-IR≥2.40），明显高于正常患者（4.7%）。在 IR 患者中，与非 IR 患者相比，RBP4 水平更高（P<0.001）。RBP4 四分位数的 IR 分布范围在 5.0%（第一四分位数）至 39.0%（第四四分位数）之间，趋势 P<0.001。RBP4 每增加 1 个单位，未调整和调整后的 IR 风险分别增加 8%（OR：1.08；95%CI：1.05-1.11，P<0.001）和 5%（1.05；1.02-1.09，P=0.001）。当将 RBP4 添加到包含已确定的显著风险因素的模型中时，AUROC（标准误差）从 0.768（0.025）增加到 0.807（0.021）。仅包含已确定的风险因素和添加 RBP4 的模型之间的 AUC 存在显著差异（差异，0.039[0.004]；P=0.02）。
血清 RBP4 水平升高与 IR 风险增加相关，可能有助于识别处于 IR 和/或葡萄糖耐量受损风险的 RA 患者，以便进行早期预防策略，尤其是肥胖和女性患者。
