类风湿关节炎患者的胰岛素抵抗发生率和程度均高于系统性红斑狼疮患者。

Higher Prevalence and Degree of Insulin Resistance in Patients With Rheumatoid Arthritis Than in Patients With Systemic Lupus Erythematosus.

机构信息

J.C. Quevedo-Abeledo, MD, S. Ojeda, PhD, MD, C. Erausquin, PhD, MD, Division of Rheumatology, Hospital Doctor Negrín, Gran Canaria, Spain.

H. Sánchez-Pérez, MD, I. Ferraz-Amaro, PhD, MD, Division of Rheumatology, Hospital Universitario de Canarias, Tenerife, Spain.

出版信息

J Rheumatol. 2021 Mar;48(3):339-347. doi: 10.3899/jrheum.200435. Epub 2020 Jun 15.

DOI:10.3899/jrheum.200435

PMID:32541071

Abstract

OBJECTIVE

Since insulin resistance (IR) is highly prevalent in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), we aimed to determine whether differences in IR exist between the two conditions.

METHODS

We conducted a cross-sectional study comprising 413 subjects without diabetes (186 with SLE and 227 with RA). Glucose, insulin, and C-peptide serum levels, as well as IR by the homeostatic model assessment (HOMA2) were studied. A multivariable regression analysis was performed to evaluate the differences in IR indexes between patients with SLE and RA, as well as to determine if IR risk factors or disease-related characteristics are differentially associated with IR in both populations.

RESULTS

The insulin:C-peptide molar ratio was upregulated in patients with RA compared to patients with SLE (β 0.009, 95% CI 0.005-0.014, < 0.001) after multivariable analysis. HOMA2 indexes related to insulin sensitivity (HOMA2-%S) were found to be lower (β -27, 95% CI -46 to -9, 0.004) and β cell function (HOMA2-%B) showed higher IR indexes (β 38, 95% CI 23-52, < 0.001) in RA than in SLE patients after multivariable analysis. Patients with RA more often fulfilled the definition of IR than those with SLE (OR 2.15, 95% CI 1.25-3.69, = 0.005). The size effect of IR factors on IR indexes was found to be equal in both diseases.

CONCLUSION

IR sensitivity is lower and β cell function is higher in RA than in SLE patients. The fact that traditional IR factors have an equal effect on IR in both SLE and RA supports the contention that these differences are related to the diseases themselves.

摘要

目的

由于胰岛素抵抗（IR）在系统性红斑狼疮（SLE）和类风湿关节炎（RA）患者中非常普遍，我们旨在确定这两种疾病之间是否存在IR 差异。

方法

我们进行了一项横断面研究，纳入了 413 名无糖尿病患者（186 名 SLE 患者和 227 名 RA 患者）。研究了血糖、胰岛素和 C 肽血清水平，以及通过稳态模型评估（HOMA2）的 IR。进行多变量回归分析，以评估 SLE 和 RA 患者的 IR 指标差异，并确定 IR 危险因素或与疾病相关的特征是否与两种人群的 IR 有差异相关。

结果

经过多变量分析，与 SLE 患者相比，RA 患者的胰岛素：C 肽摩尔比升高（β 0.009，95%CI 0.005-0.014，<0.001）。发现与胰岛素敏感性相关的 HOMA2 指标（HOMA2-%S）较低（β-27，95%CI-46 至-9，0.004），β 细胞功能（HOMA2-%B）显示更高的 IR 指数（β 38，95%CI 23-52，<0.001）RA 患者的 HOMA2 指标高于 SLE 患者。RA 患者比 SLE 患者更符合 IR 定义（OR 2.15，95%CI 1.25-3.69，=0.005）。发现 IR 因素对 IR 指标的大小效应在两种疾病中相等。