Insulin secretion improvement during steroid therapy for autoimmune pancreatitis according to the onset of diabetes mellitus
Insulin secretion improvement during steroid therapy for autoimmune pancreatitis according to the onset of diabetes mellitus
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DOI：
10.1007/s00535-019-01615-4
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发表时间：
2020-02-01
影响因子：
6.3
通讯作者：
Koike, Kazuhiko
中科院分区：
文献类型：
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作者：
Noguchi, Kensaku;Nakai, Yousuke;Koike, Kazuhiko
背景自身免疫性胰腺炎(AIP)常合并糖尿病(DM)，但有报道称DM合并AIP后激素治疗后病情好转。本研究的目的是根据糖尿病的发病情况来研究糖皮质激素治疗期间的葡萄糖耐量异常。方法对61例接受激素治疗的急性胰腺炎患者进行研究。在AIP诊断时和激素治疗4周、1年和2年后，我们评估C肽指数(CPI)、胰岛素抵抗的稳态模型评估(HOMA-R)和胰腺直径。根据糖尿病的发病情况，将患者分为三组：既有糖尿病(PDM)、并发糖尿病(CDM)和非糖尿病(NDM)。结果43例患者(71%)合并DM，其中PDM15例，CDM 28例。在诊断为急性胰腺炎时，糖尿病组(0.70，P=0.007)和糖尿病组(0.9，P=0.018)的CPI值低于非糖尿病组(1.3%，P=1.3%)。激素治疗4周后，慢性糖尿病组(P<；0.001)和非糖尿病组(P=0.021)的CPI值均有改善。激素治疗2年后，HOMA-R升高(2.1~3.0，P=0.007)，CPI逐渐改善(1.0~2.1，P=0.004)。在CDM中，23%的糖尿病患者有改善，而在CDM中，55%的胰岛素使用者停止使用胰岛素。胰腺萎缩的发生率为30%，并与DM相关。结论AIP患者的糖尿病与胰岛素分泌受损有关，而与胰岛素抵抗无关。在激素治疗并发糖尿病患者的AIP期间，胰岛素分泌得到改善。因此，糖耐量异常可作为AIP治疗的适应症。
Background Autoimmune pancreatitis (AIP) is frequently complicated by diabetes mellitus (DM), but DM associated with AIP is reported to improve after steroid therapy. The aim of this study is to investigate glucose intolerance during steroid therapy according to the onset of DM. Methods Sixty-one patients who underwent steroid therapy for AIP were included into this study. We evaluated C peptide index (CPI), homeostasis model assessment for insulin resistance (HOMA-R), and the pancreatic diameter at AIP diagnosis and after 4 weeks, 1 year, and 2 years of steroid therapy. Patients were categorized into three groups according to DM onset: Pre-existing DM (pDM), concurrent DM (cDM), and non-DM (nDM). Results Forty-three patients (71%) had DM: 15 pDM and 28 cDM. At AIP diagnosis, CPI was lower in patients with pDM (0.7, P = 0.007) and cDM (0.9, P = 0.018) than nDM (1.3). After 4 weeks of steroid therapy, CPI improved in cDM (P < 0.001) and in nDM (P = 0.021). After 2 years of steroid therapy, HOMA-R increased (2.1-3.0, P = 0.007) but CPI gradually improved (1.0-2.1, P = 0.004). DM improved in 23% of cDM, and 55% of insulin users in cDM discontinued using insulin. Pancreatic atrophy was seen in 30%, and was associated with DM. Conclusion DM in patients with AIP was associated with impaired insulin secretion rather than insulin resistance. Insulin secretion improved during steroid therapy for AIP in patients with concurrent DM. Thus, glucose intolerance can be an indication for AIP treatment.