Insulin resistance is related with oxidative stress in systemic lupus erythematosus/Sistemik lupus eritematozda insulin direnci oksidatif stres ile iliskilidir

• Published in: Anadolu kardiyoloji dergisi : AKD Vol. 9; no. 1; p. 23
• Main Authors: Koca, Suleyman Serdar, Karaca, Ilgin, Yavuzkir, Mustafa Ferzeyn, Dagli, Necati, Ozgen, Metin, Ustundag, Bilal, Isik, Ahmet
• Format: Journal Article
• Language: English
• Published: KARE Publishing 01-02-2009
• Subjects: Analysis; Atherosclerosis; Blood sugar; Coronary heart disease; Development and progression; Diabetes therapy; Glucose metabolism; Insulin resistance; Lupus; Oxidative stress; Peptides; Systemic lupus erythematosus
• ISSN: 1302-8723

Objective: Systemic lupus erythematosus (SLE) patients have increased risk of coronary heart disease (CHD) that cannot be fully explained by the traditional risk factors. Metabolic alterations like oxidative stress and insulin resistance may be additional risk factors to contribute early and accelerated atherosclerosis in SLE. Our aim was to evaluate malondialdehyde (MDA) level, oxidative stress indicator, and homeostasis model assessment of insulin resistance (HOMA-IR), and possible relationship between oxidative stress and insulin resistance, in SLE. Methods: This cross-sectional controlled study included 30 SLE patients (SLE group) and 15 age- and sex-matched healthy controls (HC group). The SLE patients were classified into subgroups based on the disease activity index as active or inactive. Serum MDA, insulin, C-peptide, fasting blood glucose, lipid profile, acute phase reactants, tumor necrosis factor (TNF)-α, interleukin (IL)-6 and HOMA-IR were determined. Statistical analyses were performed using Kruskal-Wallis, Mann-Whitney U and Pearson tests. Results: In the SLE group, TNF-α (7.9 [0.5-57.8] vs. 3.9 [0.3-6.3] pg/ml, p<0.01), IL-6 (9.2 [0.1-33.9] vs. 2.2 [0.1-4.8] pg/ml, p<0.01), MDA (2.3 [0.1-6.7] vs. 0.95 [0.5-2.96] nmol/ml, p<0.01) and C-peptide (1.9 [0.9-3.5] vs. 1.5 [1.1-2.4] ng/ml, p<0.01) levels were higher than in the HC group, while HOMA-IR index (1.7 [0.5-6.5] vs. 1.2 [0.8-2.9], p>0.05) was nonsignificantly higher. In the SLE group, MDA levels were correlated with insulin (r=0.614, p<0.05) and HOMA-IR (r=0.601, p<0.05). Conclusion: In inflammatory diseases, relations between oxidative stress and insulin resistance, each of them triggers or enhances the other one, come to an impasse. In conclusion, this modifiable impasse might be important to prevent the development of atherosclerosis in SLE. (Anadolu Kardiyol Derg 2009; 9:23-8) Key words: Insulin resistance, HOMA-IR, oxidative stress, malondialdehyde, inflammation, systemic lupus erythematosus Ozet Amac: Sistemik lupus eritematoz (SLE) hastalarinda, koroner kalp hastaligi (KKH) riskinde artis oldugu kanitlanmistir. Ancak KKH riskindeki bu artis cogu zaman klasik risk faktorleri ile aciklanamamaktadir. Sistemik lupus eritematozdaki erken ve hizlanmis aterosklerozdan, ek risk faktorleri olarak, oksidatif stres ve/veya insulin direnci gibi metabolik degisiklikler sorumlu olabilir. Bu calismada, SLE hastalarinda, oksidatif stres indikatoru malondialdehit (MDA) duzeyi ve "homeostasis model assessment of insulin resistance" (HOMA-IR) indeksinin belirlenmesi ve oksidatif stres ile insulin direnci arasindaki olasili iliskinin degerlendirilmesi amaclandi. Yontemler: Bu enine kesitli kontrollu calismaya, 30 SLE hastasi (SLE grubu) ile yas ve cinsiyet uyumlu 15 saglikli gonullu (kontrol grubu) alindi. Sistemik lupus eritematoz hastalari, hastalik aktivite indeksi skoruna gore, aktif ve inaktif olarak alt gruplara ayrildi. Serum MDA, insulin, C-peptid, aclik kan glukozu, lipit profili, akut faz reaktanlari, tumor nekrozis alpha faktor (TNF-α) ve interlokin (IL)-6 duzeyleri belirlendi ve HOMA-IR indeksi hesaplandi. Istatistiksel analizlerde Kruskal Wallis, Mann-Whitney U ve Pearson testleri kullanildi. Bulgular: Sistemik lupus eritematoz grubunda, kontrol grubuna gore TNF-α (7.9 [0.5-57.8] karsin 3.9 [0.3-6.3] pg/ml, p<0.01), IL-6 (9.2 [0.1-33.9] karsin 2.2 [0.1-4.8] pg/ml, p<0.01), MDA (2.3 [0.1-6.7] karsin 0.95 [0.5-2.96] nmol/ml, p<0.01) ve C-peptid (1.9 [0.9- 3.5] karsin 1.5 [1.1-2.4] ng/ml, p<0.01) duzeyleri yuksekti; HOMA-IR indeksi (1.7 [0.5-6.5] karsin 1.2 [0.8-2.9], p>0.05) ise goreceli artmisti. Sistemik lupus eritematoz grubunda, MDA duzeyleri, insulin (r=0.614, p<0.05) ve HOMA-IR (r=0.601, p<0.05) duzeyleri ile iliskiliydi. Sonuc: Inflamatuvar hastaliklarda, oksidatif stres ve insulin direnci arasindaki iliski, biri digerini tetikleyebilen veya duzeyini artirabilen, bir kisir dongu haline gelmektedir. Sistemik lupus eritematozda gelisebilen aterosklerotik hastaliklarin onlenmesinde, bu modifiye edilebilir kisir dongu oldukca onemli olabilir. (Anadolu Kardiyol Derg 2009; 9: 23-8) Anahtar kelimeler: Insulin direnci, HOMA-IR, oksidatif stres, malondialdehit, inflamasyon, sistemik lupus eritematoz