Aralik 2022
Insülin direncinin akut pankreatit siddetine etkisi
Insülin direncinin akut pankreatit siddetine etkisi
- Ana Sayfa
- Sayılar
- Aralik 2022
- Insülin direncinin akut pankreatit siddetine etkisi...
Sivas Cumhuriyet Üniversitesi Tip Fakültesi, 2Gastroenteroloji Bilim Dali, Sivas
Özet
Giris ve Amaç: Akut pankreatit, pankreasin çesitli nedenlere bagli inflamasyonudur. Tüm dünyada önemli bir morbidite ve mortalite nedenidir. Metabolik sendromun önemli bir komponenti olan insülin direncinin inflamatuvar bir durum olmasi nedeniyle akut pankreatit hastalarinda hastalik siddetini etkileyebilecegi düsünülmektedir. Çalismamizda insülin direncinin akut pankreatit siddeti ile iliskisini arastirmayi ve diger prognostik faktörlerle karsilastirmayi amaçladik. Gereç ve Yöntem: Çalismamizda klinikte akut pankreatit tanisi ile yatarak tedavi almis 84 hasta degerlendirmeye alinmistir. Çalismamiz prospektif olarak dizayn edilmistir. Akut pankreatit siddetini belirlemek için hastalarin laboratuvar ve görüntüleme bulgulari kullanilarak Atlanta Siniflandirmasi, ‘Bedside Index of Severity in Acute Pancreatitis’ skoru, Imrie skoru, Ranson skoru, Balthazar skoru belirlenmistir. Hastalarda insülin direnci degerlendirilmesi için “Insülin Direncinin Homeostatik Modeli Degerlendirmesi” skoru kullanilmistir. Buna göre insülin direnci olan ve olmayan gruplar arasinda hastalik siddeti açisindan fark olup olmadigi arastirilmistir. Bulgular: Hastalarin %45.2’si insülin direnci olan grupta yer aldi. Atlanta siniflandirmasina göre 6 hasta (%7.1) siddetli akut pankreatit olarak siniflandirildi. 4 hasta prerenal akut böbrek hasari gelismesi ve 2 hasta sepsis ve yogun bakim gereksinimi olmasi nedeniyle siddetli akut pankreatit olarak degerlendirildi. Hastalik siddeti açisindan yapilan Receiver Operating Characteristic analizinde Balthazar ve “Yatak basi akut pankreatit siddet indeksi” skorunun hastalarin prognozunu belirlemede güçlü olduklari görüldü (sirasiyla egri altindaki alan; 0.955 ve 0.979). Insülin direnci olan grubun “Yatak basi akut pankreatit siddet indeksi” ve Balthazar skorlari, insülin direnci olmayan grup ile karsilastirildiginda istatistiksel olarak anlamli farklilik saptandi (sirasiyla p = 0.019 ve p = 0.013). Sonuç: Çalismamizda insülin direnci olan akut pankreatit hastalarinda “Yatak basi akut pankreatit siddet indeksi” ve Balthazar skorlarinin yüksek saptanmasi, insülin direnci varliginin akut pankreatitin siddetli seyretmesi yönünde prognostik bir faktör olarak kullanilabilecegini düsündürmektedir
Abstract
Background and Aims: Acute pancreatitis is inflammation of the pancreas due to various causes. Insulin resistance is an important component of the metabolic syndrome and causes a chronic inflammatory condition, so it may affect disease severity in acute pancreatitis patients. In our study, we aimed to investigate the relationship of insulin resistance with acute pancreatitis severity and to compare it with other prognostic factors. Materials and Methods: In our study, 84 patients hospitalized in the clinic with a diagnosis of acute pancreatitis were evaluated. Our study was designed prospectively. To determine the severity of acute pancreatitis, the Atlanta Classification, Bedside Index of Severity in Acute Pancreatitis score, Imrie score, Ranson score, and Balthazar score were determined using the laboratory and imaging findings of the patients. The ‘Homeostasis Model Assessment of Insulin Resistance’ score was used to evaluate insulin resistance in patients. Accordingly, it was investigated whether there was a difference between the groups with and without insulin resistance in terms of disease severity. Results: 45.2% of the patients were in the group with insulin resistance. According to the Atlanta classification, 6 patients (7.1%) were evaluated as severe acute pancreatitis. 4 patients were evaluated as severe acute pancreatitis because of the development of prerenal acute kidney injury and 2 patients due to sepsis and need for intensive care. In the Receiver Operating Characteristic analysis performed in terms of disease severity, Balthazar and the ‘Bedside Index of Severity in Acute Pancreatitis’ score were found to be strong in determining the prognosis of the patients (Area Under the Curve; 0.955 and 0.979, respectively). When the ‘Bedside Index of Severity in Acute Pancreatitis’ and Balthazar scores of the group with insulin resistance were compared with the group without insulin resistance, a statistically significant difference was found (p = 0.019 and p = 0.013, respectively). Conclusion: The high ‘Bedside Index of Severity in Acute Pancreatitis’ and Balthazar scores in our study in acute pancreatitis patients with insulin resistance suggest that the presence of insulin resistance can be used as a prognostic factor for severe acute pancreatitis
