Insulin resistance and impaired beta cell function in rheumatoid arthritis
Insulin resistance and impaired beta cell function in rheumatoid arthritis
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DOI：
10.1002/art.22053
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发表时间：
2006-09-01
影响因子：
--
通讯作者：
Joffe, Barry I.
中科院分区：
文献类型：
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作者：
Dessein, Patrick H.;Joffe, Barry I.
客观的。确定调节类风湿性关节炎 (RA) 葡萄糖代谢的因素。方法。我们对 94 名 RA 患者的胰岛素抵抗 (HOMA-IR) 和 β 细胞功能 (HOMA-B) 的稳态模型评估进行了评估。我们研究了一般人群中已知影响葡萄糖代谢的特征（年龄、腹部肥胖[腰围]、高血压、抗高血压治疗）以及 RA 特征（疾病活动度、糖皮质激素治疗）与胰岛素抵抗和 β 细胞功能之间的关系。结果。重度炎症（高敏 C 反应蛋白值 > 1.92 毫克/升）患者 (n = 81) 比轻度炎症患者 (n = 13) 更容易出现胰岛素抵抗，而两组的 β 细胞功能相似。调整腰围后，两组的胰岛素抵抗和β细胞功能相似。在单变量分析中，除年龄外的所有记录特征均与 HOMA-IR 或/和 HOMA-B 相关。在混合回归模型中，腹部肥胖和患者对疾病活动的评估（通过视觉模拟量表）是胰岛素抵抗的预测因素。使用肿胀和压痛的 28 个关节计数评估的疾病活动评分、压痛关节计数以及患者对疾病活动的评估与 β 细胞功能降低相关，而糖皮质激素的累积剂量与 β 细胞功能增强相关。所有研究患者的累积糖皮质激素剂量平均值仅为 536 mg（95% 置信区间 239-1,173）。在患有高度炎症的患者中，年龄进一步与β细胞功能受损相关，而血管紧张素转换酶抑制剂或血管紧张素II 1型受体阻滞剂的使用与β细胞功能增强相关。结论。腹部肥胖、抗高血压治疗、疾病活动性和糖皮质激素的使用等可改变因素似乎会影响 RA 中的葡萄糖代谢。
Objective. To identify factors that regulate glucose metabolism in rheumatoid arthritis (RA).Methods. We evaluated the homeostatic model assessment of insulin resistance (HOMA-IR) and beta cell function (HOMA-B) in 94 RA patients. We investigated the relationship between characteristics known to affect glucose metabolism in the general population (age, abdominal obesity [waist circumference], hypertension, antihypertensive therapy) as well as characteristics of RA (disease activity, glucocorticoid therapy) and insulin resistance and beta cell function.Results. Patients with high-grade inflammation (high-sensitivity C-reactive protein value > 1.92 mg/liter) (n = 81) were more insulin resistant than patients with low-grade inflammation (n = 13), whereas beta cell function was similar in both groups. Insulin resistance and beta cell function were similar in both groups after adjustment for waist circumference. All recorded characteristics except for age were associated with HOMA-IR or/and HOMA-B in univariate analyses. In mixed regression models, abdominal obesity and patient's assessment of disease activity (by visual analog scale) were predictors of insulin resistance. The Disease Activity Score assessed using 28-joint counts for swelling and tenderness, tender joint count, and patient's assessment of disease activity were associated with reduced beta cell function, and the cumulative dose of glucocorticoids was associated with enhanced beta cell function. The cumulative glucocorticoid dose in all study patients was a mean of only 536 mg (95% confidence interval 239-1,173). In patients with high-grade inflammation, age was further associated with impaired beta cell function, whereas use of angiotensin-converting enzyme inhibitors or angiotensin II type 1 receptor blockers was associated with enhanced beta cell function.Conclusion. The modifiable factors of abdominal obesity, antihypertensive therapy, disease activity, and use of glucocorticoids appear to affect glucose metabolism in RA.