INSULIN RESISTANCE AND METABOLIC SYNDROME IN SURVIVORS OF ACUTE LYMPHOCYTIC

这个子项目是利用资源的许多研究子项目之一。 由NIH/NCRR资助的中心拨款提供。对子项目的主要支持 子项目的首席调查员可能是由其他来源提供的， 包括美国国立卫生研究院的其他来源。为子项目列出的总成本可能 表示该子项目使用的中心基础设施的估计数量， 不是由NCRR赠款提供给次级项目或次级项目工作人员的直接资金。 背景：儿童急性淋巴细胞白血病(ALL)的幸存者患肥胖症、胰岛素抵抗和代谢综合征的风险增加。虽然众所周知，ALL治疗期间的高血糖预示着感染和死亡等不良后果，但与幸存者合并疾病的相关性仍不清楚。我们假设，与正常血糖的幸存者相比，所有在诱导期间有高血糖病史的儿童幸存者患胰岛素抵抗和代谢综合征的风险都更高。 方法：我们计划对40名儿童幸存者进行前瞻性研究，他们都是1999-2006年确诊的，目前在德克萨斯州儿童癌症中心长期幸存者诊所接受治疗。受试者将根据在ALL诱导治疗期间是否有高血糖被平均分为2组。每个受试者都将接受口服葡萄糖耐量测试和身体成分的DEXA扫描，以及胰岛素抵抗、血脂和血压的测量。采用双样本t检验比较两组患者的平均胰岛素抵抗。将对代谢综合征、高血压、血脂异常和肥胖等结局进行卡方检验。 结果/结论：我们希望检测到两组之间胰岛素抵抗的显著差异，以HOMA衡量，为2.4。我们预测，与那些在诱导期间保持正常血糖的ALL幸存者相比，有高血糖史的ALL幸存者更有可能表现出胰岛素抵抗。此外，我们预计在高血糖组中会发现更高的并存率，如糖耐量受损、肥胖、高血压、血脂异常和代谢综合征。如果我们的假设得到证实，未来的研究将需要检验诱导期间的高血糖治疗作为减少所有幸存者合并症的一种手段所起的作用。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. Primary support for the subproject and the subproject's principal investigator may have been provided by other sources, including other NIH sources. The Total Cost listed for the subproject likely represents the estimated amount of Center infrastructure utilized by the subproject, not direct funding provided by the NCRR grant to the subproject or subproject staff. Background: Survivors of childhood Acute Lymphocytic Leukemia (ALL) are at increased risk for obesity, insulin resistance, and metabolic syndrome. While it is well established that hyperglycemia during treatment for ALL predicts adverse outcomes such as infections and death, the association with co-morbidities seen in survivors remains unknown. We hypothesize that survivors of childhood ALL with a history of hyperglycemia during induction are at increased risk to develop insulin resistance and metabolic syndrome when compared to euglycemic counterparts. Methods: We plan to conduct a prospective study of 40 survivors of childhood ALL who were diagnosed 1999-2006 and are currently cared for in the Texas Childrens Cancer Center Long-Term Survivor Clinic. Subjects will be divided equally into 2 groups based on presence or absence of hyperglycemia during induction therapy for ALL. Each subject will undergo an oral glucose tolerance test and a DEXA scan for body composition along with measurements of insulin resistance, lipids, and blood pressure. A 2 sample t-test will be used to compare mean insulin resistance between the 2 groups. A chi 2 analysis will be performed for outcomes such as metabolic syndrome, hypertension, dyslipidemia, and obesity. Results/Conclusions: We expect to detect a significant difference in insulin resistance, measured as HOMA, of 2.4 between our two groups. We predict that survivors of ALL with a history of hyperglycemia compared to those who remained euglycemic during induction will be more likely to exhibit insulin resistance. Additionally, we expect to find higher rates of co-morbidities such as impaired glucose tolerance, obesity, hypertension, dyslipidemia, and metabolic syndrome in the hyperglycemia group. If our hypotheses are proven, future studies will be needed to examine the role of hyperglycemia therapy during induction as a means of decreasing co-morbidities in ALL survivors.