Sekrecija insulina i insulinska senzitivnost perifernih tkiva pre i nakon radikalnog lečenja primarnog hiperparatireoidizma
Insulin secretion and insulin sensitivity of peripheral tissues before and after radical treatment of primary hyperparathyroidism
Докторанд
Cvijović, Goran M.Ментор
Micić, DraganЧланови комисије
Žarković, MilošKendereški, Aleksandra
Hajduković, Zoran
Метаподаци
Приказ свих података о дисертацијиСажетак
Uvod i cilj: Prethodno je uočeno postojanje insulinske rezistencije i povećana prevalenca
oštećene tolerancije na glikozu i tipa 2 dijabetesa kod pacijenata sa primarnim
hiperparatireoidizmom. Efekat paratireoidektomije na insulinsku senzitivnost je praćen
kontraverznim nalazima u zavisnosti od metode koja je korištena za procenu insulinske
senzitivnosti: nije bilo promene kada su korišteni HOMA i QUICKI dok je Minimalnim
modelom pokazano značajno poboljšanje insulinske senzitivnosti.Cilj ovog rada je bio da se
proceni insulinska senzitivnost pre i nakon paratireoidektomije kod pacijenata sa PHPT
putem euglikemijskog hiperinsulinemijskog klampa. Materijal i metode: Kod 44 pacijenta
sa PHPT i 11 zdravih kontrola komparabilne starosti i indeksa telesne mase procenjivali smo
insulinsku senzitivnost (pomoću tehnike klampa, HOMA IR i ISI indeksa), insulinsku
sekreciju (putem površine pod krivom za glikemije i insulinemije tokom OGTTa i
izračunavajući akutni insulinski odgovor iz podataka do...bijenih IVGTTom), lipidni profil i
nivo hsCRP kao marker hronične inflamacije. Rezultati: Pre operacije vrednosti M indeksa i
HOMA IR su ukazivale na postojanje insulinske rezistencije kod pacijenata sa PHPT. Nije
bilo razlike u M indeksu (3.74±1.89 vs 4.62±2.27, p >0.05), HOMA IR (2.94±1.39 vs.
3.29±0.81, p > 0.05), AUC glikoze (863.0±261.3 vs 842.3±165.5, p>0.05), AUC insulina
(7068.7±4159.0 vs 7229.6±2581.7, p>0.05), ISI (4.73±2.77 vs 4.25±2.94, p>0.05) i AIR
(47.89±32.05 vs. 38.96±21.20, p>0.05) izmeĎu pacijenata sa PHPT i zdravih kontrola. Došlo
je do značajnog poboljšanja insulinske senzitivnosti nakon operacije al ii preoperativna i
postoperativna vrednost M indeksa se nisu razlikovale od zdravih kontrola. Nije uočena
promena u HOMA IR, AUC za glikozu i insulin ISI i AIR, lipidima i hsCRP nakon operacije.
Zaključak: Dobili smo značajno poboljšanje insulinske senzitivnosti nakon
paratireoidektomije kod pacijenata sa PHPT koristeći klamp tehniku. Postoperativno nije do
došlo do značajne promene u drugim pokazateljima insulinske senzitivnosti, paramtrima
insulinske sekrecije, lipidima i hsCRP.
Background and Aims: Previous studies demonstrated insulin resistance and increased
prevalence of impaired glucose tolerance and type 2 diabetes mellitus in patients with
primary hyperparathyroidism (PHPT). The effect of curative parathyroidectomy on insulin
sensitivity was associated with conflicting results depending on which method for measuring
the insulin sensitivity has been used. There was no improvement using HOMA and QUICKI
while minimal model demonstrated significant improvement in insulin sensitivity. The aim
of our study was to evaluate the insulin sensitivity before and after parathyroidectomy in
patients with PHPT using a euglycemic clamp. Material i methods: Forty-four patients with
PHPT and eleven age and body mass index matched healthy controls participated in study
protocol. We measured insulin sensitivity using euglycemic clamp technique, HOMA IR and
ISI. Insulin secretion was evaluated using area under the curve for glucose and insulin during
OGTT and calculating th...e acute insulin response durin IVGTT. Also, lipid profile and hsCRP
were evaluated Results: Before surgery M values and HOMA IR suggest insulin resistance in
patients with PHPT. There was no difference in M index (3.74±1.89 vs 4.62±2.27, p >0.05),
HOMA IR (2.94±1.39 vs. 3.29±0.81, p > 0.05), AUC glucose (863.0±261.3 vs 842.3±165.5,
p>0.05), AUC insulin (7068.7±4159.0 vs 7229.6±2581.7, p>0.05), ISI (4.73±2.77 vs
4.25±2.94, p>0.05) and AIR (47.89±32.05 vs. 38.96±21.20, p>0.05) between patients with
PHPT and HC. There was significant improvement in insulin sensitivity after
parathyroidectomy but both preoperative and postoperative M values were not significantly
different in comparison to HC. There were no significant changes in HOMA IR, AUC
glucose, AUC insulin, ISI and AIR before and after therapy, as well in lipid and hsCRP
levels. Conclusion: we observed significant improvement in insulin sensitivity after
parathyroidectomy in patients with PHPT. There was no difference in parameters of insulin
secretion before and after parathyroidectomy in patients with PHPT.