The relationship between insulin resistance and glucocorticoids in patients with systemic lupus erythematosus / 天津医药

ABSTRACT

Objective To evaluate insulin resistance (IR) in patients with systemic lupus erythematosus (SLE) and investigate the effect of glucocorticoids on IR and its clinical significance. Methods Three hundred and one SLE patients and 103 healthy volunteers hospitalized in our hospital from May 2013 to May 2017 were included in this study. Homeostasis model assessment (HOMA) was used to calculate insulin resistance index (HOMA-IR), HOMA-βcell function index (HBCI) and insulin sensitivity index (ISI). The IR grouping was determined by using the upper 1/4 of the HOMA-IR index of 103 healthy volunteers as the cut point. According to the dose of glucocorticoids in the last 3 months, the SLE group was divided into glucocorticoids>7.5 mg/d group,≤7.5 mg/d group and without glucocorticoids group. These parameters were compared with all groups respectively. Furthermore, related factors for HOMA-IR were analyzed by linear correlation. Results Compared with control group, triacylglycerol (TG, P<0.01), fasting insulin (FINS, P<0.01), HOMA-IR (P<0.01), HOMA-HBCI (P<0.05) were significantly increased and high-density lipoprotein cholesterol (HDL-C, P<0.01) and ISI (P<0.01) were significantly lower in SLE group. However, there were no significant differences in TG, FINS, HOMA-IR and ISI between different doses of glucocorticoid groups (P>0.05). The level of HOMA-HBCI was significantly higher in two groups with glucocorticoids than that without glucocorticoid group and normal control group (P<0.05), while there was no significant difference in HOMA-HBCI between without glucocorticoid group and the normal control group ( P>0.05). HOMA-IR was positively correlated with fasting blood glucose (FBG, r=0.566, P<0.01), FINS (r=0.949, P<0.01) and HOMA-HBCI (r=0.280, P<0.01). But there was a negative correlation between TG (r=-0.139, P<0.01) and ISI (r=-0.896, P<0.01). Conclusion Insulin secretion is abnormal and the incidence of IR is elevated in SLE patients. Long term glucocorticoid therapy may be involved in the formation of IR.