Exocrine and Endocrine Pancreatic Insufficiency in Development of Atherosclerosis

Abstract

Objective: To evaluate the effect of chronic pancreatitis (CP) and exocrine insufficiency of the pancreas on the carotid intima media thickness (cIMT) in patients with type 2 diabetes mellitus (DM-2). Materials and methods: 91 patients were examined, they were divided into groups: 1st group-patients with DM-2 (n = 31) group 2nd – DM-2 combined with CP (n = 60). Fasting plasma glucose (FPG), HbA1c, immunoreactive insulin (IRI), HOMA-IR index, C-reactive protein (CRP), serum α-amylase and fecal-1 elastase (FE-1) were assessed. In order to assess the thickness of the cIMT, ultrasound of the common carotid artery was performed. The control group of healthy volunteers was representative by age and sex. Results: In the 1st and 2nd groups, the average value of cIMT was (1.02 ± 0.1 vs 1.21 ± 0.15) mm. Parameters of DM-2 management in the 1st and 2nd groups were (FPG 8.18 ± 0.92vs8.57 ± 1.2) mmol / l; HbA1c (7.23 ± 0.21vs7.49 ± 0.36)%; IRI (20.31 ± 0.9vs22.53 ± 1.2) μIU / ml; HOMA-IR (6.55 ± 1.5vs8.38 ± 2.2) μIU / ml * mmol / l; PSA (1.3 ± 0.12vs6.77 ± 0.31). HOMA-IR correlated with: CRP (r = 0.43, p <0.05 in group 1; r = 0.61, p <0.05 in group 2); FE-1 (r = -0.55, p <0.05 of the 2nd group); and cIMT (r = 0.42, p <0.05 in the 1st group; r = 0.53, p <0.05 in the 2nd group). IRI have relationship with: FE-1 (r = 0.41, p <0.05 in group 1; r = -0.3, p <0.05 in group 2); CRP (r = 0.42, p <0.05 in group 1; r = -0.28, p <0.05 in group 2); HbA1c had close relationships with cIMT (r = 0.38, p <0.05 in group 1; r = 0.51, p <0.05 in group 2). The relationship between cIMT and CRP was related in the 2nd group (r = 0.39, p <0.05); with α-amylase (r = 0.2, p <0.01 2nd group). There was no significant relationship between cIMT and FE-1 in the study. Conclusions: Obtained data allows us to conclude that hyperinsulinemia and insulin resistance have a direct atherogenic effect on the walls of blood vessels. It is established that the accession of the inflammatory process leads to increasing development of atherosclerotic lesions of the vessel, at the same time, the presence of exocrine dysfunction of the pancreas does not have a significant direct effect on the cIMT.