Insulinska rezistencija kod nelečenih bolesnika sa multiplom sklerozom

  • Smiljana Kostić Military Medical Academy, Clinic of Neurology, Belgrade, Serbia.
  • Ivana Kolić Institute of Nuclear Sciences “Vinča”, Laboratory for Radiobiology and Molecular Genetics, Belgrade, Serbia.
  • Ranko Raičević Military Medical Academy, Clinic of Neurology, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia.
  • Zvezdana Stojanović University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia; Military Medical Academy, Clinic of Psychiatry, Belgrade, Serbia;
  • Dejan Kostić Military Medical Academy, Institute of Radiology, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia.
  • Evica Dinčić Military Medical Academy, Clinic of Neurology, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia.
DOI: https://doi.org/10.2298/VSP160218082K
Ključne reči: multiple sclerosis||, ||multipla skleroza, insulin resistance||, ||insulin, rezistencija, glucose tolerance test||, ||glukoza, test tolerancije, surveys and questionnaires||, ||ankete i upitnici,

Sažetak


Uvod/Cilj. S obzirom na činjenicu da ima relativno malo podataka koji se odnose na sistemske insulinske poremećaje u multiploj sklerozi (MS), osnovni  cilj našeg istraživanja bio je da utvrdimo da li kod obolelih od MS sa prirodnim tokom bolesti postoji disbalans u metabolizmu glukoze i insulina. Naša hipoteza je da metabolički poremećaj koji karakteriše stanje insulinske rezistencije (IR) i snižene insulinske senzitivnosti (IS)  kod nelečenih bolesnika sa MS može imati ulogu u progresiji bolesti i stepenu funcionalne onesposobljenosti. Metode. U studiju je bio uključen 31 bolesnik sa dijagnozom relapsno remitentne (RR) MS i 14 zdravih kontrolnih ispitanika sa istog geografskog područja usaglašenih po starosti, etničkoj pripadnosti, i zastupljenosti pušača. Tolerancija na glukozu, IS i IR procenjivani su na osnovu oralnog testa opretećenja glukozom (OGTT) i bazalnih vrednosti insulina i glukoze u serumu. Za kliničku procenu funkcionalne onesposobljenosti i progresije bolesti korišćeni su  Expanded Disability Status Scale (EDSS) i Multiple Sclerosis Severity Score (MSSS) skorovi. Rezultati. Bolesnici sa MS jednako su dobro tolerisali glukozu kao i kontrolna grupa zdravih. U grupi MS bolesnika bazalne koncentracije insulina u plazmi bile su statistički značajno veće (p < 0,05) kao i koncentarcije insulina 30 min nakog opterećenja glukozom (p < 0,01). Značajno veće vrednosti indeksa IR, i Homeostasis Model Assessment (HOMA-IR), imali su bolesnici sa MS nego zdrava kontrola. Pokazane su značajno niže vrednosti procenta IS (HOMA 2%S) i indeksa insulinske senzitivnosti celog tela (ISI Matsuda) kod MS bolesnika nego kod kontrolne grupe (p = 0,005; p = 0,001). Insulinogeni indeks u prvih 30 min OGTT-a bio je značajno veći kod bolesnika sa MS. Ispitivani parametri IR i indeksi IS nisu pokazali značajnu povezanost sa stepenom funkcionalne onesposobljenosti i progresijom MS. Zaključak. U ovoj studiji  je po prvi put pokazano prisustvo hiperinsulinemije, smanjene IS uz očuvanu toleranciju na glukozu, što sve zajedno ukazuje na postojanje inicijalne faze sindroma IR kod bolesnika sa prirodnim tokom MS. Neophodna su dodatna istraživanja za definisanje mehanizama nastanka i uticaja IR na kompleksne patofiziološke procese kod MS.

Biografije autora

Smiljana Kostić, Military Medical Academy, Clinic of Neurology, Belgrade, Serbia.
Neurology department, MD neurologist
Ivana Kolić, Institute of Nuclear Sciences “Vinča”, Laboratory for Radiobiology and Molecular Genetics, Belgrade, Serbia.

 

Laboratory for Radiobiology and Molecular Genetics, PhD

Ranko Raičević, Military Medical Academy, Clinic of Neurology, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia.
Department of Neurology, MD PHD neurologist
Zvezdana Stojanović, University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia; Military Medical Academy, Clinic of Psychiatry, Belgrade, Serbia;
Department of Psychiatry, MD psychiatrist
Dejan Kostić, Military Medical Academy, Institute of Radiology, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia.
Institute of Radiology. MD radiologist
Evica Dinčić, Military Medical Academy, Clinic of Neurology, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia.
Deparmtent of Neurology. PhD neurologist

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Objavljeno
2017/07/07
Broj časopisa
Vol. 74 Br. 6 (2017)
Rubrika
Originalni članak