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Sažetak
Uvod: Prema rezultatima dosadašnjih istraživanja, ustanovljeno je da se disfunkcija IGF (engl. insulin-like growth factor) sistema, koja je u osnovi insulinske rezistencije sa hiperinsulinemijom, ponaša kao proliferatogeni tumorski faktor, a svoj neoplastični potencijal pokazuje i u multiplom mijelomu.
Cilj: Cilj studije je ispitivanje eventualne povezanosti insulinske rezistencije kod novodijagnostikovanih bolesnika obolelih od multiplog mijeloma (NDMM) sa postignutim terapijskim odgovorom nakon sprovedene indukcione hemioterapije.
Materijali i metode: Sprovedeno je prospektivno istraživanje koje je obuhvatilo 35 pacijenata sa NDMM-om (60% žena i 40% muškaraca), lečenih na Klinici za hematologiju Kliničkog centra Vojvodine. Vrednosti glikemije i insulinemije su određivane našte i postprandijalno a potom su izračunavane vrednosti HOMA-IRIn (našte) i HOMA-IRIpp (postprandijalno). Vrednosti HOMA-IRI > 2,2 su bile kriterijum za insulinsku rezistenciju. Analize su rađene u dva navrata – pre inicijalne hemioterapije i posle završenog lečenja. Procena terapijskog odgovora je sprovedena prema kriterijumima Srpske mijelomske grupe (SMG) i Međunarodne radne grupe za mijelom (engl. International Myeloma Working Group – IMWG). Statističke analize su sprovedene u SPSS programu (Verzija 22).
Rezultati: Bolesnici su bili prosečne starosti od 63,85 godina. Ukupno 86% bolesnika je povoljno odgovorilo na terapiju. Prosečna vrednost HOMA-IRIn pre terapije je bila 1,82 ± 0,79, a posle terapije 1,80 ± 0,72. Centralna vrednost medijane HOMA-IRIpp pre terapije je bila 5,46 sa interkvartalnim rasponom od 1,07 – 20,57, a posle terapije je bila 5,86 sa interkvartalnim rasponom od 1,22 – 28,22. Uočena je značajna negativna korelacija HOMA-IRIn nakon primenjene terapije i postignutog terapijskog odgovora (p = 0,040).
Zaključak: Aktivna konkomitantna terapija insulinske rezistencije kod NDMM-a bi mogla da unapredi odgovor na primenjenu antimijelomsku terapiju.
Ključne reči
multipli mijelom
terapijski odgovor
Reference
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