İnsülin direncinin Bell’s palsy hastalarında House-Brackman evrelemesi üzerine etkisi

Öz

Amaç: Bell’s palsi  fasial sinir lezyonun en sık nedenidir ve diyabetli hastalarda sık izlenir ve iyileşme süresi diyabetli hastalarda  gecikmiştir. Bell’s palys  geçiren hastalarda insulin resistansının House – Brackman evrelemesi üzerine etkisini araştırmak ve bu araştırma sonucunda Bell’ palsi tedavisi planlamadan önce öncelikli olarak insulin direncinin bakılmasının önemini araştırmak.

Yöntemler: Çalışmaya fasial paralizi şüphesiyle ilk 24 saat içinde acile veya polikliniğe başvuran ve bu nedenle  steroid almamış hastalar dahil edildi. Bell’s palys’li hastaların demografik verileri toplanıldı. Endokrin hastalığı olmayan çeşitli yaş gruplarında normal vücut kitle endexi olan hastalar çalışmaya alındı. Fasia paralizinin derecesinin  değerlendirilmesi için  House-Brackman klinik skalası kullanıldı. Tüm hastaların rutin laboratuar testlerine ek olarak açlık insülin seviyeleri bakıldı ve  HOMA-IR değeri hesaplandı. 

Sonuçlar: Çalışmaya alınan 19 hastanın 10’u kadın (%52.6) diğeri erkekti.  Çalışmaya katılan hastaların ortlama yaşı 33 glucose değeri ise 106 (mg/dL)  ortalama insulin değeri 15.9 (µU/mL) ve ortalama HOMA-IR değeri ise 4.1 idi. Ortalama glucose değeri ile HOMA-IR değeri arasında istatistiksel olarak pozitif yönde orta şiddette anlamlı korelasyon saptanmıştır (r=0.548; P=0.015) Yaş ve glucose değerleri ile insülin ve HOMA-IR değerleri arasında istatistiksel olarak anlamlı bir ilişkiye rastlanmamıştır (sırasıyla p=0.858, p=0.015).

Tartışma: Fasial sinir felci ilen başvuran hastaların çoğunun kan şekeri yüksek ve ortlama insulin değerleri toplumdan daha fazla izlendi. Hastaların büyük çoğunluğunda IR pozitifliğine rastlanıldı. Bu yüzden Bell’s palsi ile başvuran tüm hastlarda insulin rezsitansına bakıklmasını ve tedavi planın ve gelecekte hastada gelişebilecek bir diyabet açısından dikkatli olunmasını önermekteyiz.

Anahtar Kelimeler

• İnsülin resistansı,House-Brackman,Fasial paralizi

The effect of insulin resistance on House-Brackmann grade of facial paralysis in patients with Bell’s palsy

Abstract

Aim: Bell's palsy is the most common cause of facial nerve lesion and is frequently observed in diabetic patients and the duration of healing is delayed in diabetic patients. To investigate the effect of insulin resistance on the facial paralysis as graded by the House-Brackmann classification in patients with Bell’s palsy and to determine the importance of insulin resistance assessed primarily prior to treatment planning .

Methods: Patients admitting to our emergency department and outpatient neurology clinic with suspected facial paralysis who were not administered steroid therapy within the first 24 hours were studied. Demographic data were collected for patients with Bell’s palsy from different age groups with a normal body mass index (BMI) and no chronic endocrine disease. The House-Brackmann (HB) grading scale was used to assess the clinical severity of the facial paralysis. In addition to routine laboratory tests, fasting insulin level was obtained to estimate HOMA-IR (Homeostatic model assessment for insulin resistance) for all patients. 

Results: Of 19 patients enrolled, 10 were female (52.6%). Patients had a mean age of 33 years, mean glucose value of 106 mg/dL, mean insulin value of 15.9 µU/mL and mean HOMA-IR value of 4.1. A moderate positive correlation and a statistically significant association were found between mean glucose values and HOMA-IR values (r=0.548; P=0.015) Age and glucose values were not statistically significantly associated with insulin and HOMA-IR values (p=0.858 and p=0.015, respectively). 

Conclusion: Higher blood glucose and average insulin levels were found in patients with facial nerve paralysis in comparison to general population. Most of the patients were IR-positive. Therefore, assessment of insulin resistance would be beneficial for both treatment planning and taking proactive measures against future development of diabetes in all patients presenting with Bell’s palsy.

Keywords

• Insulin resistance,House-Brackmann,Facial paralysis

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