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Vojnosanitetski pregled
2017, vol. 74, br. 6, str. 564-571
jezik rada: engleski
vrsta rada: izvorni naučni članak
doi:10.2298/VSP160218082K

Creative Commons License 4.0
Insulinska rezistencija kod nelečenih bolesnika sa multiplom sklerozom
aMilitary Medical Academy, Clinic of Neurology, Belgrade
bUniverzitet u Beogradu, Institut za nuklearne nauke Vinča
cMilitary Medical Academy, Clinic of Neurology, Belgrade + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade
dUniversity of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade + Military Medical Academy, Clinic of Psychiatry, Belgrade
eMilitary Medical Academy, Institute of Radiology, Belgrade + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade

e-adresa: popovicsmiljana@gmail.com

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.

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