İnsülin direnci olan hastalarda homosistein düzeylerinin değerlendirilmesi

Öz

Anahtar Kelimeler

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İnsülin direnci olan hastalarda homosistein düzeylerinin değerlendirilmesi

Öz

Amaç: İnsülin direnci, hiperhomosisteinemi ve obezite kardiyovasküler hastalıklar için önemli bir risk faktörüdür. Buna rağmen insülin direnci, homosistein düzeyi ve obezite arasındaki ilişki ile ilgili tartışmalar devam etmektedir. Biz çalışmamamızda bu parametreler ve sendromun ilişkisini incelemeyi amaçladık. Gereç ve yöntem: Hastanemize başvurmuş ve tetkikleri yapılmış olan 80 hastanın insülin direnci, homosistein düzeyi, bel kalça oranı (BKO), beden kitle indeksi (BKİ), yağ yüzdesi, rutin biyokimyasal parametreleri kaydedildi. Bulgular: İnsülin direnci olan hastaların homosistein düzeyleri, BKİ ve yağ yüzdeleri insülin direnci olmayanlara göre yüksekti. BKO, açlık kan şekeri, tokluk kan şekeri ve lipid değerleri açısından ise fark yoktu. Sonuç: İnsülin direnci olanlarda kardiyovasküler risk artmış olduğundan, bir başka risk faktörü olarak hiperhomosisteineminin de bulunması bu hastaların daha yakından izlenmesi gerektirdiğini düşündürmektedir

Anahtar Kelimeler

• İnsülin direnci, homosistein, obesite

Kaynakça

1. Bray GA, Bouchard C, James WPT (Editörler). Handbook of obesity. In:Dekker M, New York; 1998:183-89
2. Kopelman P. Health risks associated with overweight and obesity. Obes Rev 2007; 8( 1):13-7
3. Keys A, Fidanza F, Karvonen MJ, Kimura N, Taylor HL. Indices of relative weight and obesity. J Chronic Dis 1972;25(6):329-43.
4. National Institutes of Health. Executive summary of the clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. Archives of Internal Medicine 1998;158(17):1855-67.
5. World Health Organisation (WHO) Expert Committee. Physical Status: The use and interpretation of anthropometry. Technical Report Series no.854. WHO, Geneva
6. Ducimetiere P, Eschwege E, Papoz L, et al. Relationship of plasma insulin levels to the incidence of myocardial infarction and coronary heart disease mortality in a middle- aged population. Diabetologia 1980;19(3):205-210
7. Despres JP, Lamarche B, Mauriege P, et al. Hyperinsulinemia as an independent risk factor for ischemic heart disease. N Engl J Med. 1996;334(15):952-7
8. Dhawan J, Bray CL, Warburton R, et al. Insulin resistance, high prevalence of diabetes, and cardiovascular risk in immigrant Asians: Genetic or environmental effect? Br Heart J. 1994;72(5):413-21

9. Sheu WH, Jeng CY, Young MS, et al: Coronary artery disease risk predicted by insulin resistance, plasma lipids, and hypertension in people without diabetes. Am J Med Sci 2000;319(2):84-88
10. Reaven GM: Role of insulin resistance in human disease. Diabetes 1988;37(12):1595-607
11. Ndrepepa G, Kastrati A, Braun S, et al. Circulating Homocysteine Levels in Patients with Type 2 Diabetes Mellitus. Nutr Metab Cardiovasc Dis 2008;18(1):66-73.
12. Vrentzos G, Papadakis JA, Malliaraki N, et al. Association of serum total homocysteine with the extent of ischemic heart disease in a Mediterranean cohort. Angiology 2004;55(5):517-24.
13. McCully KS. Homocysteine theory of arteriosclerosis: Development and current status. Atherosclerosis Rev 1983; 11(3): 157-246.
14. D'Angelo A, Mazzola G, Crippa L, Fermo I, D'Angelo SV. Hyperhomocysteinemia and venous thromboembolic disease. Haematologica 1997; 82(2): 211-9.
15. Schini-Kerth VB. Homocysteine, A Proinflammatory and Proatherosclerotic Factor: Role of Intracellular Reactive Oxygen Species. Circ Res 2003;93(4):271-3.
16. Nygard O, Nordrehaug JE, Refsum H, et al.. Plasma homocysteine levels and mortality in patients with coronary artery disease. N Eng J Med,1997; 337(4):230- 236
17. Boushey CJ, Beresford SA, Omenn GS, Motulsky AG. A quantitative assessment of plasma homocysteine as a risk factor for vascular disease. Probable benefits of increasing folic acid intakes, J. Am. Med. Assoc. 1995;274(13):1049– 57
18. Kalita J, Kumar G, Bansal V, Misra UK. Relationship of homocysteine with other risk factors and outcome of isch- emic stroke. Clin Neurol Neurosur 2009;111(4):364-7.
19. Meigs JB, Jacques PF, Selhub J, et al. Fasting plasma homocysteine levels in the insulin resistance syndrome. The Framingham 2001;24(8):1403-10 Study. Diabetes Care
20. T. Kilic-Okman, S. Guldiken, M. Kucuk. Relationship between homocysteine and insulin resistance in women with polycystic ovary syndrome. Endocr. J. 2004;51(5) 505– 8.
21. Godsland IF, Rosankiewiez JR, Proudler AJ, et al. Plasma total homocysteine concentrations are unrelated to insulin sensitivity and components of the metabolic syndrome in healthy men. J Clin Endocrinol Metab 2001;86(2):719-23
22. Tanrikulu-Kilic F, Bekpinar S, Unlucerci Y, Orhan Y. Insulin resistance is not related to plasma homocysteine concentration in healthy premenapausal women. Physiol. Res. 2006;55(3):285-90.
23. Wald NJ, Watt HC, Law MR, et al. Homocysteine and ischemic heart disease: results from a prospective study with implications regarding prevention. Arch Intern Med 1988;158(8):862-7
24. Graham IM, Daly LE, Refsum HM, et al. Plasma homocysteine as a risk factor for vascular disease. European 1997;277(22):1775-81 R, Project. JAMA 25. Clarke Daly L, Robinson K, et al. Hyperhomocysteinemia: An independent risk factor for vascular disease. N Engl J Med. 1991324(17):1149-55
25. Arneson E, Refsum H, Bonaa KH, et al. Serum total homocysteine and coronary heart disease. Int J Epidemiol. 1995;24(4):704-709
26. Gallistl S, Sudi K, Mangge H, et al. Insulin is an independent correlate of plasma homocysteine levels in obese children and adolescents. Diabetes Care. 2000;23(9):1348-52
27. Giltay EJ, Hoogeveen EK, Elbers JM, et al. Insulin resistance is associated with elevated plasma total homocysteine levels in healthy, non-obese subjects. Atherosclerosis 1998;139(1):197-8
28. Emoto M, Kanda H, Shoji T, et al. Impact of insulin resistance and nephropathy on homocysteine in type 2 diabetes. Diabetes Care. 2001;24(3):533-8
29. Sanchez-Margalet V, Valle M, Ruz FJ, et al. Elevated plasma total homocysteine levels in hyperinsulinemic obese subjects, J. Nutr. Biochem. 2002;13(2):75–79.
30. Fonseca VA, Fink LM, Kern PA. Insulin sensitivity and plasma homocysteine concentrations in non-diabetic obese and normal weight subjects, Atherosclerosis 2003;167 (1) 105–9.
31. Jacobs RL, House JD, Brosnan ME, Brosnan JT. Effects of streptozotocin-induced diabetes and of insulin administration on homocysteine metabolism in the rat, Diabetes 1998;47(12):1967–70.
32. Dicker-Brown A, Fonseca VA, Fink LM, Kern PA, The effect of glucose and insulin on the activity of methylenetetrahydrofolate reductase and cystathionine- beta-synthase: studies in hepatocytes. Atherosclerosis 2001;158(2):297–301.
33. Najib S, Sanchez-Margalet V. Homocysteine thiolactone inhibits insulin signaling, and glutathione has a protective effect, J. Mol. Endocrinol. 2001;27(1):85–91.
34. Najib S, Sanchez-Margalet V. Homocysteine thiolactone inhibits insulin-stimulated DNA and protein synthesis: possible role of mitogen-activated protein kinase (MAPK), glycogen synthase kinase-3 (GSK-3) and p70 S6K phosphorylation. J. Mol. Endocrinol. 2005;34(1)119–26.
35. Ceriello A, Pirisi M. Is oxidative stress the missing link resistance between Diabetologia. 1995;38(12):1484–5. and atherosclerosis?
36. Wittmann I, Nagy J. Are insulin resistance and atherosclerosis the consequences of oxidative stress? Diabetologia 1996;39(8):1002–3.
37. Pixa A, Pietzsch J, Julius U, et al. Impaired glucose tolerance (IGT) is not associated with disturbed homocysteine metabolism. Amino Acids 2000;18(3):289-98
38. Abbasi F, Facchini F, Humphreys MH, et al. Plasma homocysteine concentrations in healthy volunteers are not related to differences in insulin-mediated glucose disposal. Atherosclerosis 1999;146(1):175-8
39. Oron-Herman M, Rosenthal Hyperhomocysteinemia as a component of syndrome X. Metabolism 2003;52(11):1491–5 T, Sela BA.