二甲双胍联合糖皮质激素治疗伴糖耐量异常的系统性红斑狼疮患者的临床研究

目的: 探究二甲双胍联合糖皮质激素治疗伴糖耐量异常(IGT)的系统性红斑狼疮(SLE)患者的临床疗效及对胰岛功能、Th17/Treg细胞失衡的影响。方法: 本院84例伴IGT的SLE患者随机分为联用组和对照组各42例,均给予生活、饮食指导,对照组给予糖皮质激素治疗,联用组联合二甲双胍治疗,1个月后观察疗效,并评估胰岛功能和Th17/Treg细胞失衡情况。结果: 联用组总有效率明显高于对照组(90.48% vs. 71.43%,P<0.05),SLE活动指数评分为(2.6±0.3)分,红细胞沉降率(ESR)为(18±4)mm/h,显著低于对照组的(3.9±0.8)分、(23±4)mm/h(P<0.05)。治疗后联用组空腹血糖(FBG)、空腹胰岛素(Fins)、稳态模型-胰岛素抵抗指数(HOMA-IR)、胰岛β功能细胞指数(HOMA-β)显著改善(P<0.05),且与对照组相比差异有统计学意义(P<0.05);联用组正常糖耐量(NGT)占比明显高于对照组(73.81% vs. 30.95%,P<0.05)。治疗后联用组Th17、Treg细胞比例为(6.2±0.9)个/μL、(31±7)个/μL,Th17/Treg为(0.20±0.05),与对照组的(7.4±1.3)个/μL、(28±7)个/μL、(0.26±0.06)相比有统计学差异(P<0.05)。治疗后SLE活动指数评分与HOMA-IR、HOMA-β及Th17细胞、Treg细胞、Th17/Treg明显相关(P<0.05),且HOMA-IR、HOMA-β与Th17细胞、Treg细胞、Th17/Treg也明显相关(P<0.05)。2组不良反应均轻微,发生率无统计学差异(P>0.05)。结论: 二甲双胍联合糖皮质激素治疗伴IGT的SLE患者疗效显著,可控制疾病活动性,降低血糖水平、改善胰岛功能及纠正Th17/Treg细胞失衡,且安全性高。

Metformin combined with glucocorticoid in the treatment of SLE patients with IGT

AIM: To investigate the clinical curative effect of metformin combined with glucocorticoids in the treatment of patients with systemic lupus erythematosus (SLE) complicated with impaired glucose tolerance (IGT) and the effect on islet function and Th17/Treg cell imbalance. METHODS: Eighty-four patients with SLE complicated with IGT were randomly divided into the combined group and the control group with 42 cases in each group. All of them were given life and diet guidance. The control group was treated with glucocorticoids while the combined group was treated with metformin combined with glucocorticoids. One month later, the curative effect was observed, and islet function and Th17/Treg cell imbalance were evaluated. RESULTS: The total response rate of the combined group was significantly higher than that of the control group (90.48% vs. 71.43%, P<0.05). The SLE activity index score and the erythrocyte sedimentation rate (ESR) (2.6±0.3) points, (18±4) mm/h] were significantly lower than those in the control group (3.9±0.8) points, (23±4) mm/h] (P<0.05). Fasting blood glucose (FBG), fasting insulin (Fins), steady-state model-insulin resistance index (HOMA-IR) and islet β-functioning cell index (HOMA-β) in the combined group were significantly improved after treatment (P<0.05). There were statistically significant differences between the two groups (P<0.05). The proportion of NGT in the combined group was significantly higher than that in the control group (73.81% vs. 30.95%, P<0.05). The ratios of Th17 and Treg cells in the combined group were (6.2±0.9) /μL and (31±7) /μL, and Th17/Treg was (0.20±0.05). Compared with the control group (7.4±1.3) /μL, (28±7) /μL, (0.26±0.06)], there were statistically significant differences (P<0.05). The SLE activity index scores after treatment were significantly correlated with HOMA-IR, HOMA-β and Th17 cells, Treg cells, Th17/Treg (P<0.05). Besides, HOMA-IR and HOMA-β were significantly correlated with Th17 cells, Treg cells and Th17/Treg (P<0.05). The adverse reactions in both groups were mild, and there was no statistically significant difference in the incidence (P>0.05). CONCLUSION: Metformin combined with glucocorticoids is effective in the treatment of SLE with IGT. The treatment can control disease activity, lower blood glucose levels, improve islet function and correct Th17/Treg cell imbalance with high safety.