Lupus：SLE患者代谢综合征发病率与激素用量无关

为明确中国系统性红斑狼疮（SLE）患者合并发生代谢综合征（MS）的发病率，并调查促成其发病的条件，来自郑州大学第一附属医院风湿科的刘升云等人进行了一项研究。研究结果发表于2013年5月的《狼疮》（Lupus）杂志上。研究发现，中国SLE患者的代谢综合征发病率与其激素用量、血浆皮质醇水平无明显相关。

研究纳入了116例符合美国风湿病学会（ACR）所提出分类标准的SLE患者，并同时纳入了115例对照组病例。MS的诊断基于以下几个机构的临时联合申明而明确：国际糖尿病联盟疾病流行预防工作小组；美国国家心脏、肺、血液研究所；美国心脏联合会；世界心脏基联盟；国际动脉粥样硬化协会；国际肥胖研究协会（IDF/NHLBI/AHA/WHF/IAS/IASO）。SLE病情特征及治疗方案在研究过程中进行评估。

研究检测了30例新近诊断而尚未接受治疗的SLE患者的空腹胰岛素及皮质醇激素水平，33例年龄和性别相匹配的对照组病例同时接受上述检测。研究发现，MS在SLE患者中的发生率为34.2%，在对照组中为14.8%（p=0.002）。合并MS的狼疮患者应用羟氯喹（HCQ）的比例较低（16.0% vs 45.8%，p=0.012）。未经治疗的SLE患者其空腹胰岛素水平较高（10.92±13.53 vs 5.48±5.43 uU/ml，p＜0.001），16点血浆皮质醇水平亦较高（257.22±177.98 vs 139.84±63.46 nmol/l，p=0.001），但其8点血浆皮质醇水平较低（195.51±149.84 vs 278.95±136.27 nmol/l，p=0.024）。合并或不合并MS的狼疮患者之间，其激素用量、胰岛素水平及皮质醇水平无明显统计学差异。

中国SLE患者与对照组病例相比，其表现出更高的MS患病率及空腹胰岛素水平。但MS与激素用量、血浆皮质醇水平之间无明显相关性。治疗方案中加用HCQ可预防MS。SLE患者皮质醇的昼夜节律可能存在异常。

Metabolic syndrome in Chinese patients with systemic lupus erythematosus: no association with plasma cortisol level.
Abstract
Our objective was to determine metabolic syndrome (MS) prevalence in Chinese patients with systemic lupus erythematosus (SLE) and to investigate the conditions that contribute to its development. 116 patients with SLE classified according to the American College of Rheumatology (ACR) classification criteria, and 115 controls were enrolled. MS was defined by the joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity (IDF/NHLBI/AHA/WHF/IAS/IASO). SLE features and treatment of SLE were assessed. Fasting insulin and cortisol levels of 30 newly diagnosed, untreated patients and 33 age and sex-matched controls were detected. MS prevalence was 34.2% in patients with SLE and 14.8% in controls (p=0.002). Lupus patients with MS had less frequency of hydroxychloroquine (HCQ) intake (16.0% vs 45.8%; p=0.012). Untreated patients with SLE had higher levels of fasting insulin (10.92 ± 13.53 vs 5.48 ± 5.43 uU/mL, p<0.001) and plasma cortisol at 16:00 (257.22 ± 177.98 vs 139.84 ± 63.46 nmol/L, p=0.001), but lower plasma cortisol at 08:00 (195.51 ± 149.84 vs 278.95 ± 136.27 nmol/L, p=0.024). Comparisons regarding steroid therapy, levels of insulin and cortisol were not statistically significant between patients with MS and without MS. The Chinese patients with SLE presented a higher MS prevalence and fasting insulin than controls. MS was not associated with the steroid therapy and plasma cortisol. HCQ use proved to be protective against MS. The circadian rhythm of cortisol may differ in patients with SLE.