Hayrunnisa BULUT YILDIZ, Zülfikar AKELMA, Sacit GÜNBEY

İnhale Kortikosteroidlerin Prepubertal Astımlı Çocuklarda İnsülin Direnci Üzerine Etkisi

Amaç: Astım sık hastane başvurusu, ilaç kullanımı ve yaşam kalitesi bozukluğuna neden olan kronik bir hastalıktır. Astım tedavisinde kullanılan inhale kortikosteroidlerin (İKS) insülin direnci üzerindeki etkisi ile ilgili yeterince çalışma bulunmamaktadır. Bu çalışmada, prepubertal dönemde İKS kullanan astımlı çocuklarda İKS’nin insülin direnci üzerindeki etkisini araştırmak amaçlandı. Araçlar ve Yöntem: Çalışmaya en az 1 ay idame astım tedavisi alan astımlı çocuklar ve sağlıklı çocuklar dâhil edildi. Hastaların açlık glikoz, açlık insülin, VKİ ve Homeostatis model assesment insülin resistansı (HOMA-IR) değerleri karşılaştırıldı. Bulgular: Çalışmaya 117 astımlı çocuk ve 103 sağlıklı çocuk olmak üzere toplam 220 kişi dahil edildi. Astımlı çocuklar aldıkları idame tedaviye göre İKS grubu (n=60) ve montelukast grubu (n=57) olarak ikiye ayrıldı. Grupların demografik bulguları arasında istatiksel anlamlı fark yok idi. Astımlı hastalarda kullanılan total kümülatif inhale kortikosteroid dozları karşılaştırıldığında İKS grubunda medyan 40 (7.75-1090) mg iken montelukast grubunda medyan 3.75 (0-50) mg olarak tespit edildi (p<0.01). Grupların açlık glikoz ve açlık insülin düzeyleri ve HOMA-IR düzeyleri benzer saptandı. İKS grubunda açlık glikoz, açlık insülin, VKİ, IgE ve deri prik testi ile kortikosteroid dozları arasında istatistiksel olarak anlamlı bir ilişki bulunmadı. Ancak HOMA-IR ile idame kümülatif ve total kümülatif kortikosteroid dozu arasında pozitif ilişki saptandı (p= 0.017). Sonuç: Çalışmada astımlı çocukların kullandığı kümülatif kortikosteroid miktarı ile insülin rezistansı arasında pozitif ilişki olduğu saptandı. Astımlı çocuklarda uzun süreli ve yüksek dozda kortikosteroid kullanımının insülin direncine neden olacağını düşünülmektedir.

Anahtar Kelimeler:

açlık glikoz, açlık insülin, homeostasis model assessment insulin resistance(HOMA-IR), kümülatif kortikosteroid doz, montelukast

The Effect of Inhaled Corticosteroids on Insulin Resistance in Prepubertal Children with Asthma

Purpose: Asthma is a chronic disease that causes frequent hospital admissions, medication use and impaired quality of life. The purpose of this study was to investigate the effect on insulin resistance of ICS in children with asthma using ICS in the prepubertal period. Materials and Methods: Asthmatic children receiving at least one month of maintenance asthma treatment and healthy children were included in the study. Patients’ fasting glucose, fasting insulin, BMI, and homeostasis model assessment insulin resistance (HOMA-IR) values were compared. Results: Two hundred twenty individuals were included in the study, 117 asthmatic and 103 healthy children. The children with asthma were divided into two groups depending on the maintenance treatment received-ICS (n=60) and montelukast (n=57). The median total cumulative inhaled corticosteroid doses were 40 mg (7.75-1090) in the ICS group and 3.75 mg (0-50) in the montelukast group (p<0.01). The groups’ fasting glucose, fasting insulin, and HOMA-IR levels were similar. It has been revealed no statistically significant relationship between fasting glucose, fasting insulin, BMI, IgE, or the skin prick test and corticosteroid doses in the ICS group. However, a positive correlation was found between HOMA-IR and maintenance cumulative and total cumulative corticosteroid doses (p=0.017). Conclusion: A positive correlation was determined between the cumulative amount of corticosteroid used by children with asthma and insulin resistance. We think that prolonged and high-dose corticosteroid use by children with asthma will cause insulin resistance.

Keywords:

cumulative corticosteroid dose, fasting glucose, fasting insülin, homeostasis model assessment insulin resistance (HOMA-IR), montelukast,

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