Sekrecija insulina i insulinska senzitivnost perifernih tkiva pre i nakon radikalnog lečenja primarnog hiperparatireoidizma

Abstract

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 dobijenih 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 the 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.