摘要 目的 曾有研究显示羟氯喹可降低非风湿病性糖尿病患者的糖化血红蛋白，故我们检测了伴糖尿病的风湿病患者开始用羟氯喹或甲氨蝶呤的糖化血红蛋白变化。方法 利用电子档案证实使用羟氯喹或甲氨蝶呤治疗伴糖尿病或糖化血红蛋白≥7%的风湿病患者，且在开始治疗前及治疗后12个月内至少有检查过1次糖化血红蛋白，记录其诊断、口服激素情况、体重指数、年龄和性别。调整线性回归模型计算用药前到用药后12个月内糖化血红蛋白最低值的变化。结果 总共有45例使用羟氯喹和37例甲氨蝶呤患者符合标准，其中有一半患者为类风湿关节炎。羟氯喹组和甲氨蝶呤组的年龄、性别和用药前糖化血红蛋白水平相似，羟氯喹组的体重指数(35.4 kg/m(2)比甲氨蝶呤组 (32.2 kg/m2) 稍高 (p = 0.13)，甲氨蝶呤组(46%)的糖皮质激素使用率比羟氯喹组更多(29%) (p = 0.17)。但羟氯喹组使用前后的糖化血红蛋白平均降低值为0.66% (95% CI 0.26~1.05)而甲氨蝶呤组为0.11% (95% CI -0.18- 0.40)，通过调整分析发现，羟氯喹组的糖化血红蛋白降低程度比甲氨蝶呤组高0.54%(p = 0.041)。结论： 与甲氨蝶呤相比，合并糖尿病的风湿病患者用羟氯喹治疗可明显降低糖化血红蛋白。

附原文：Abstract OBJECTIVE: Prior research demonstrates that hydroxychloroquine (HCQ) lowers glycated hemoglobin (HbA1c) in non-rheumatic diabetic patients. We examined medical records of patients with diabetes mellitus (DM) and concomitant rheumatic illness to measure changes in HbA1c after starting HCQ or methotrexate (MTX). METHODS: We utilized electronic medical records to identify patients initiating either HCQ or MTX, with a diagnosis of DM or HbA1c >/= 7%, and with at least one HbA1c measurement before and within 12 months after initiation. A structured medical record abstraction examined rheumatologic diagnosis, use of oral glucocorticoids, body mass index, age, gender. Adjusted linear regression models determined changes in HbA1c from pre-drug values to the lowest post-drug values within twelve months. RESULTS: We identified 45 HCQ users and 37 MTX users who met inclusion criteria. Half in each group carried a rheumatoid arthritis diagnosis. Age, gender, and mean pre-drug HbA1c levels were similar across groups. Mean BMI for HCQ users (35.4 kg/m(2)) was slightly higher than MTX users (32.2 kg/m(2)) (p = 0.13). Glucocorticoid use appeared more common in MTX (46%) than HCQ (29%) users (p = 0.17). The mean reduction in HbA1c between pre- and post-HCQ was 0.66% (95% CI 0.26 - 1.05) versus 0.11% (95% CI -0.18- 0.40) for MTX. In fully adjusted analyses, the reduction in HbA1c among HCQ users was 0.54% greater than the drop among MTX users (p = 0.041). CONCLUSION: HCQ initiation was associated with a significantly greater reduction in HbA1c as compared to MTX initiation among diabetic patients with rheumatic disease.

引自：Rekedal LR, Massarotti E, Garg R, et al. Changes in glycated hemoglobin after initiation of hydroxychloroquine or methotrexate in diabetic patients with rheumatologic diseases. Arthritis Rheum. 2010 Aug 18. [Epub ahead of print]