Особливості вуглеводного обміну у хворих на бронхіальну астму з ожирінням

Abstract

Asthma (As) and metabolic disturbances are widespread and socially significant states, obesity (Ob) being also one of them. The comorbidity of As and Ob both affects physiological mechanisms of bronchial obstruction syndrome, the course and prognosis of these two diseases and significantly complicates their treatment. A combination of changes in ventilation and a complex architectonics of the bronchi may contribute to worsening control over As. The performed study deals with the problem of early diagnosis and progression of the course in patients with comorbidity of As and Ob. The study involved 62 patients with As. Of them, there were 24 cases with the normal body mass (Group I) and 38 cases with As+Ob (Group II). Side by side with evaluation of their respiratory function values and anthropometric examination, all the patients underwent controlling of their carbohydrate metabolisms. It was found out that As combined with Ob were accompanied by a cascade of metabolic disorders: hyperinsulinemia, insulin resistance, and higher levels of HbA1с and fasting glucose versus the control group (р<0.05). According to correlation analysis data, Group II revealed negative correlations between values of HOMA-IR and 40≤FEV1<50% (r = -0.53; р<0.05), HOMA-IR and 50%≤FEV1<60% (r = -0.49; р<0.05), insulin level and 40≤FEV1<50% (r = -0.42; р<0.05) as well as a positive correlation between HPMA-IR value and BMI (r = 0.39; р<0.05). Conclusions. Patients with As, degree 1 Ob and a disorder of FEV1>60% revealed hyperinsulinemia and an increased level of insulin resistance index; this fact can be regarded as a prognostic criterion for an improved diagnosis, prognostication of unfavorable consequences and optimization of treatment approaches. In order to detect carbohydrate metabolic disturbances in patients with As+Ob it is not enough to determine levels of glucose and glycated hemoglobin. The necessity of studying insulin resistance and insulin level for systematization and determination of development of concomitant metabolic disturbances in the patients, whom ICS are prescribed, is proved.