Цель: оценка диагностической ценности С-пептида и модифицированных индексов HOMA при различных нарушениях углеводного обмена (НУО) на фоне терапии глюкокортикоидами. Материалы и методы: обследованы 193 пациента, с диагнозом системная красная волчанка (СКВ)-63, системный васкулит (СВ)-45 и хронический гломерулонефрит (ХГН)-76 человек, из которых 98 человек получали пульс-терапию глюкокортикоидами (ПТГК) (1 серия в 3 сеанса), а 95-терапию ГК per os. Всем пациентам проведены стандартные клинико-лабораторные исследования, пероральный глюкозо-толерантный тест (ПГТТ), а также оценка С-пептида, индексов HOMA-IR и HOMA-islet. Результаты: проведение ПГТТ выявило, что у пациентов, принимающих ГК per os, нарушение гликемии натощак (НГН), нарушение толерантности к глюкозе (НТГ), сахарных диабет (СД) развиваются статистически значимо чаще, чем при ПТГК. У пациентов обеих групп с выявленными СД и НТГ значения С-пептида и индекса HOMA-IR до проведения лечения и ПГТТ были выше, чем при отсутствии НУО и НГН, что говорит о наличии инсулинорезистентности у данной категории больных. При СД выявлено снижение секреторной функции β-клеток, что проявлялось в виде снижения показателей индекса HOMA-islet. Заключение: НУО реже встречаются при проведении ПТГК, чем при терапии per os. Индекс HOMA-IR может быть использован для прогноза развития НУО у больных на фоне интенсивной терапии ГК, а также при длительной per os терапии. Ключевые слова: глюкокортикоиды, углеводный обмен, С-пептид, индекс HOMA. Для цитирования: Валеева Ф.В., Нуруллина Г.И. Диагностическая ценность С-пептида и модифицированных индексов HOMA при различных нарушениях углеводного обмена на фоне терапии глюкокортикоидами. Медицинский

BackgroundHOMA-IR index is widely used in current clinical practice for the evaluation of insulin resistance (IR). Elevation of HOMA-IR index is an indirect marker of IR progression.ObjectivesTo evaluate the role of modified HOMA-IR index in patients with rheumatic diseases receiving glucocorticoid (GC) therapy.MethodsThe study included 98 patients with rheumatic diseases, including systemic lupus erythematosus (SLE) - 53 patients and systemic vasculitis (SV) – 45 patients. The first group included 52 patients receiving GC pulse-therapy (GC-PT) (prednisolone 10–15 mg/kg a day i/v, on 3 consecutive days), the second group included 46 patients receiving oral prednisolone 15–30 mg/day. The first group included 31 (59.6%) women and 21 (40.4%) men aged 18–69 years. Control group included 27 (58.7%) women and 19 (41.3%) men aged 19–63 years. All patients underwent standard clinical evaluation and an oral glucose tolerance test (OGTT): patients receiving GC-PT underwent OGTT 72 hours after the end of PT course, patients receiving oral GC – during the time of inpatient treatment. According to OGTT results patients were divided into 4 groups: no carbohydrate metabolism disturbance (CMD), impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and diabetes mellitus (DM). IR calculation according to HOMA-IR index was performed according to a formula proposed by X. Li et al. (2004): Homa-IR =1,5 + fasting blood glucose (mmol/l) x fasting C-peptide level (pmol/l) /2800.ResultsCMD developed in 10 (33.3%) patients in SLE group receiving GC-PT, compared to 18 (81.8%) patients receiving oral GC (p=0.002). In SV patients CMD was more prevalent in those receiving oral GC compared to GC-PT (4 (19.1%) vs. 19 (79.2%) patients, respectively (p=0.035). HOMA-IR index, reflecting the degree of IR, was elevated in patients with IGT and DM at baseline, during maximal blood glucose level and after GC-PT, compared to patients without CMD and IFG (p<0.05). IR was more pronounced in patients receiving oral GC and IGT and DM after OGTT (p<0.05), which demonstrates that a more pronounced IR during GC therapy predisposes to the development of more pronounced CMD.ConclusionsGC therapy results in the development of IGT and DM in patients with elevated IR after GC-PT or prolonged oral GC treatment. CMD is more prevalent among patients receiving prolonged oral GC therapy.Disclosure of InterestNone declared

BackgroundDiabetogenic effect limits the use of glucocorticoids (GC), especially in patients with diabetes risk factors. At present HOMA index is widely used for the evaluation of insulin resistance (IR) and β-cell function. HOMA-IR index increase is an indirect measure of IR progression and cardiovascular risk elevation.ObjectivesTo evaluate the role of modified HOMA-IR and HOMA-islet indices in different carbohydrate metabolism disorders (CMD) during oral (OGCT) and PULSE (GCPT) glucocorticoid therapy (GCT).MethodsA prospective study including 118 patients with systemic lupus erythematosus (SLE) (n=63) and systemic vasculitis (SV) (n=55) was performed. Seventy one patients received GCPT (i.v. infusion of 10–15 mg/kg of prednisolone with 250 ml of normal saline per day, for 3 consecutive days (1 course of 3 sessions); course dose was 1800–3000 mg; 47 patients received oral GC 15–30 mg/day. HOMA-IR index and β-cell function (HOMA-islet index) were calculated as follows: Homa-IR =1.5 + fasting blood glucose (mmol/l) x fasting C-peptide level (pmol/l) /2800. HOMA-islet =0.27 x fasting C-peptide level (pmol/l)/(fasting blood glucose (mmol/l) – 3,5).ResultsGCPT was associated with less CMD compared to OGCT. Impaired fasting glucose (IFG) was observed in 7 (9.9%) and 9 (19.1%), impaired glucose tolerance (IGT) – in 9 (12.7%) and 14 (29.8%) and diabetes mellitus (DM) – in 9 (12.7%) and 13 (27.7%) patients in GCPT and OGCT groups, respectively. There was a significant decrease of HOMA-islet during glycemic peak in DM patients from 13.96 to 6.17 after GCPT (p<0.05), compared to insignificant changes in other groups. Decrease of HOMA-islet index reflects a disturbance of overall functional activity of β-cells in DM patients. After a course of GCPT HOMA-islet index was significantly lower in DM patients compared to patients with no CMD (11.8 vs. 15.4), as GCPT is associated with a decrease of β-cell function which does not return to baseline as a consequence of β-cell reserve depletion. No rapid decrease of β–cell function was observed in OGCT group, instead there was a compensatory increase, which was insufficient to maintain normoglycia because of high insulin resistance. C-peptide, HOMA-IR and HOMA-islet levels in OGCT patients demonstrated the same trend as in GCPT patients. Significant differences were observed in patients with IGT and DM before and after oral glucose tolerance test (OGTT) on C-peptide (1042 pmol/l vs. 1978 pmol/l in IGT; 1306 pmol/l vs. 2286 pmol/l in DM) and HOMA-IR (4.53 vs. 9.81 in IGT; 5.6 vs. 11.27 in DM patients), whereas in patients without CMD and in patients with IFG, C-peptide before OGTT was 489 pmol/l vs. 743 pmol/l, after - 1295 pmol/l vs. 1488 pmol/l, HOMA-IR – 2.59 vs. 2.88 before OGTT and 2.88 vs. 5.85 after the test in the absence of CMD and in IFG patients, respectively. A significant decrease of β–cell function was observed in DM patients, reflected by a decrease of HOMA-islet index after OGTT compared to baseline (147 vs. 78.4).ConclusionsEvaluation of blood glucose level, which wa...

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The purpose — to study the features of vaccination, including against COVID-19, in patients with immune-mediated rheumatoid inflammatory diseases (IMRID). Material and methods. A review of the scientific literature about vaccination, including vaccination against COVID-19, in patients with immune-mediated inflammatory rheumatoid diseases. Results. Patients with IMRID are at risk of infectious diseases with a more severe course and outcome. This problem has become more urgent with the emergence of COVID-19 and the need for vaccination against it. Infectious diseases in IMRID patients may have a more severe source, thus, their vaccination is recommended. However, introduction of DMARDs and GEBDs into clinical practice leads to a decrease in the vaccination effectiveness. The specific role of vaccines in the induction of autoimmune diseases has been actively discussed over the past decade. However, apart from some specific vaccine complications, this role has not been established. COVID-19 can also exacerbate IMRID. Therefore, vaccination should be recommended to these patients. The increase in IMRID symptoms after the vaccine introduction did not in all cases reflect a true exacerbation and cannot serve as a basis for refusing to vaccinate. The preserved sensibility to the disease may be explained by the lack of humoral response combined with insufficient T-cell response. Conclusions. Therefore, vaccination is recommended for patients with IMRID. At the same time, vaccination is recommended against the background of low activity or remission of IMRID 6 months after and 4 weeks before the course of B-cell therapy. Immunological complications after vaccination are relatively rare, but they should not be underestimated, in this regard, it is necessary to carefully monitor patients in the post-vaccination period.