problendoПроблемы ЭндокринологииProblems of Endocrinology0375-96602308-1430Endocrinology Research Centre10.14341/probl201561123-30problendo-7136Research ArticleСтатьиArticlesМеханизмы нарушений углеводного обмена при акромегалии в зависимости от леченияMechanisms of development of carbohydrate metabolism disturbances in acromegalic patients depending on treatmentДревальА ВDrevalA V-ТриголосоваИ ВTrigolosovaI Vtrigolosova_ira@mail.ruВиноградоваА ВVinogradovaA V-ГБУ Здравоохранения Московской Области «Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского», МоскваM.F. Vladimirsky Moscow Regional Research Clinical Institute, Moscow201515022015611ТОМ 61, №1 (2015)2330Copyright © Древаль А.В., Триголосова И.В., Виноградова А.В., 20152015Древаль А.В., Триголосова И.В., Виноградова А.В.Dreval A.V., Trigolosova I.V., Vinogradova A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.probl-endojournals.ru/jour/article/view/7136

Обследовали 110 больных акромегалиeй: 62 больных впервые выявленной акромегалией (de novo), 25 на терапии аналогами соматостатина (АСС) и 23 после транссфеноидальной аденомэктомии (ТСА). Распространенность нарушений углеводного обмена (НУО) в группах de novo, АСС и ТСА составила 53,3, 88,0 и 43,4% соответственно. Уровень инсулина плазмы натощак (ИПН) и индекс инсулинорезистентности НОМА-IR не отличались в группах АСС и ТСА и были более, чем в 1,5 раза ниже, чем в группе de novo (p<0,05). Площадь под инсулинемической кривой в течение 30 мин перорального глюкозотолерантного теста (ПГТТ) (AUС инс.30) в группе АСС была в 5,3 раза ниже, чем в группе ТСА, и в 6,7 раза ниже, чем в группе de novo (p<0,05). Среди 23 больных de novo контролируемой фазы акромегалии через 6 мес в группах АСС и ТСА достигли 46 и 50% больных соответственно. В группе АСС обнаружено увеличение уровня глюкозы плазмы натощак (ГПН), НbА1с (р=0,05), в группе ТСА - снижение ГПН (p<0,05). В группах АСС и ТСА обнаружена тенденция к снижению НОМА-IR (р=0,06), снижение ИПН и AUCинс. (p<0,05). Степень снижения AUС инс.30 на терапии АСС превышала степень снижения AUC инс.30-120 (в 11 и 2,3 раза соответственно; р<0,05), а после ТСА изменения были сопоставимы (2,4 и 3,2 раза соответственно; p<0,05). Несмотря на сопоставимое снижение инсулинорезистентности на фоне терапии АСС и после ТСА, снижение первой фазы секреции инсулина на фоне терапии АСС ведет к развитию НУО.

110 acromegalic patients were examined: 62 patients with newly diagnosed acromegaly (de novo), 25 patients were receiving somatostatin analogues treatment (SSA) and 23 patients underwent transsphenoidal sugery (TSS). The prevalence of carbohydrate metabolism disturbances (CMDs) in groups de novo, the SSA and the TSS was 53.3, 88.0 and 43.4%, respectively. Levels of fasting plasma insulin (FPI), index of insulin resistance (HOMA-IR index) did not differ in groups SSA and TSS and were more than 1.5 times lower than in the de novo group (p<0.05). Аrea under insulin curve in the first 30 minutes (AUC ins.30) of oral glucose tolerance test in the SSA group was 5.3 times lower than in the TSS, and 6.7 times lower than in the de novo group (p<0.05). Among the 23 de novo patients controlled acromegaly in 6 months was at 46% in group SSA and 50% of patients TSS. In the SSA group there were found increase of fasting plasma glucose levels (FPG), HbA1c (p=0.05), in the TSS group - decrease of FPG (p<0.05). There were the tendency to decrease of HOMA-IR (p=0.06), decrease of FPI and AUCins. (p<0.05) in SSA and TSS groups. Extent of decrease in AUCins.30 on SSA therapy exceeded the extent of decrease in UC ins.30-120 (in 11.0 and 2.3 times, respectively, p<0.05), but after TSS - these changes were comparable (2.4 and 3.2 times, respectively, p<0.05). Despite comparable reduction in insulin resistance on SSA therapy and after TSS decrease of the first phase of insulin secretion on SSA therapy leads to the development of CMD.

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The authors declare that there are no conflicts of interest present.