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Функциональные и клинико-морфологические изменения поджелудочной железы при метаболическом синдроме
Функциональные и клинико-морфологические изменения поджелудочной железы при метаболическом синдроме
Звенигородская Л.А., Хачатурян Н.Э. Функциональные и клинико-морфологические изменения поджелудочной железы при метаболическом синдроме. Consilium Medicum. 2016; 18 (8): 51–58. DOI: 10.26442/2075-1753_2016.8.51-58
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Аннотация
В предлагаемой статье рассматриваются тесная взаимосвязь эндо- и экзокринной функций поджелудочной железы (ПЖ), а также развитие стеатоза ПЖ у пациентов с метаболическим синдромом (МС). Показано, что у больных с нарушениями эндокринной функции ПЖ отмечаются выраженные изменения внешнесекреторной функции ПЖ. Пусковым механизмом прогрессирования патологии ПЖ при МС выступает воспаление, тесно сопряженное с жировой инфильтрацией органа на фоне ожирения. При стеатозе ПЖ у больных с МС развивается дисфункция b-клеток с последующим формированием нарушения толерантности к глюкозе и развитием сахарного диабета (СД) типа 2. В рамках диагностики ПЖ помимо ультразвукового исследования, компьютерной и магнитно-резонансной томографии в настоящее время используется тонкоигольная аспирационная биопсия ПЖ, что позволяет получить более точную морфологическую картину ПЖ при стеатозе у пациентов с МС и СД типа 2. Учитывая сопряженность МС со стеатозом ПЖ, представляется важным уточнение состояния ПЖ у больных с МС.
Ключевые слова: поджелудочная железа, экзокринная и эндокринная часть, функции, ферменты, инсулин, глюкагон.
Ключевые слова: поджелудочная железа, экзокринная и эндокринная часть, функции, ферменты, инсулин, глюкагон.
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This article discusses a close relationship of the endo- and exocrine functions of the pancreas (pancreatic), and the development of pancreatic steatosis in patients with metabolic syndrome (MS). It is shown that in patients with disorders of the endocrine pancreas function observed marked changes in exocrine function of the pancreas. The trigger mechanism of the progression of pancreatic pathology in MS inflammation appears closely paired with fatty infiltration of the body on the background of obesity. With pancreatic steatosis in patients with MS the b-cell dysfunction with subsequent formation of impaired glucose tolerance and development of diabetes mellitus (DM) type 2 develops. As part of the diagnosis of pancreas besides ultrasound, computed and magnetic resonance imaging is currently used by fine-needle aspiration biopsy pancreas that allows you to get a more accurate picture of the morphological RV with steatosis in patients with the metabolic syndrome and diabetes type 2. Given the contingency MS with steatosis RV, it is important to clarify the state of the pancreas in patients with MS.
Key words: pancreas, exocrine and endocrine part, function, enzymes, insulin, glucagonum
Key words: pancreas, exocrine and endocrine part, function, enzymes, insulin, glucagonum
Полный текст
Список литературы
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2. Korot'ko G.F. Sekretsiia podzheludochnoi zhelezy. Krasnodar: Izd-vo Kubanskogo meditsinskogo universiteta, 2005. [in Russian]
3. Gorelick F, Pandol, SJ, Topazian M. Pancreatic physiology, pathophysiology, acute and chronic pancreatitis. Gastrointestinal Teaching Project, American Gastroenterologic Association. 2003.
4. Keller J, Layer P, Johnson CD et al. Acinarislet interactions: Pancreatic exocrine insufficiency in diabetes mellitus: Pancreatic disease: Basic science and clinical management. Eds. C.D.Johnson, C.W.Imrie et al. London, 2004; 21: 267–78.
5. Pandol SJ. The Exocrine Pancreas. University of California. Morgan&Claypool Life Sciences, 2010.
6. http://www.uptodate.com/contents/insulin-secretion-and-pancreatic-beta-cell-function?source=search_r...
7. Petunina N.A., Trukhina L.V., Sinitsyna E.I., Shestakova M.V. Gliukagon i a-kletki – novaia terapevticheskaia mishen' v lechenii sakharnogo diabeta. Sakharnyi diabet. 2013; 3: 35–40. [in Russian]
8. Dedov I.I., Shestakova M.V. Sakharnyi diabet: diagnostika, lechenie, profilaktika. 2011; s. 42–57. [in Russian]
9. Bykov V.L. Chastnaia gistologiia cheloveka. SPb.: SOTIS, 2007; s. 113–7. [in Russian]
10. Dedov I.I., Iashkov Iu.I., Ershova E.V. Inkretiny i ikh vliianie na techenie sakharnogo diabeta 2 tipa u patsientov s morbidnym ozhireniem posle bariatricheskikh operatsii. Ozhirenie i metabolizm. 2012; 2: 5–7. [in Russian]
11. Schaefer JH. The normal weight of the pancreas in the adult human being: A biometric study. Anat Rec 1926; 32: 119–32.
12. Ogilvie, R.F. A quantitative estimation of the pancreatic islet tissue. Q J Med 1937; 6: 287–300.
13. Olsen TS. Lipomatosis of the pancreas in autopsy material and its relation to age and overweight. Acta Path Microbiol Scand 1978. Sect. A; 86: 367–73.
14. Mathur A, Marine M, Lu D et al. Nonalcoholic fatty pancreas disease. HPB 2007; 9: 312–8.
15. Gullo L, Salizzoni E, Serra C et al. Can pancreatic steatosis explain the finding of pancreatic hyperenzymemia in subjects with dyslipidemia? Pancreas 2006; 33 (4): 351–3.
16. Hsieh PS, Chan JY, Shyu JF et al. Mild portal endotoxinemia induces subacute hepatic inflammation and pancreatic beta-cell dysfunction in rats. Eur J Clin Invest 2008; 38 (9): 640–8.
17. Van Geenen E-J, Smits MM, Schreuder TC et al. Nonalcoholic Fatty Liver Disease Is Related to Nonalcoholic Fatty Pancreas Disease. Pancreas 2010; 39 (Issue 8): 1185–90.
18. Lazebnik L.B., Zvenigorodskaia L.A. Metabolicheskii sindrom i organy pishchevareniia. M.: Anakharsis, 2009. [in Russian]
19. Gubergrits N.B., Kaziulin A.N. Metabolicheskaia pankreatologiia. Donetsk, 2011. [in Russian]
20. Fain JN, Madan AK, Hiler ML et al. Comparison of the release of adipokines by adipose tissue, adipose tissue matrix, and adipocytes from visceral and subcutaneous abdominal adipose tissues of obese humans. Endocrinology 2004; 145: 2273–82.
21. Cai D, Yuan D, Frantz F et al. Local and systemic insulin resistance resulting from hepatic activation of IKK-beta and NF-kappaB. Nat Med 2005; 11: 183–90.
22. Arkan MC, Hevener AL, Greten FR et al. IKK-beta links inflammation of obesity-related insulin resistance. Nat Med 2005; 11: 191–8.
23. Misu H, Ishikura K, Kurita S et al. Inverse Correlation between Serum Levels of Selenoprotein P and Adiponectin in Patients with Type 2 Diabetes. PLoS ONE 2012; 7 (4): 349–52.
24. Fantuzzi G, Mazzone T. Adipose tissue and atherosclerosis: Exploring the connection. Arteriosc Thromb Vasc Biol 2007; 27: 996–1003.
25. Shifrin O.S. Osobennosti lechebnoi taktiki u bol'nykh khronicheskim pankreatitom srednetiazhelogo techeniia razlichnoi etiologii. Dis. … d-ra med. nauk. M., 2008. [in Russian]
26. Mathur A, Zyromski NJ, Pitt HA et al. Pancreatic Steatosis Promotes Dissemination and Lethality of Pancreatic Cancer. J Am Col Surg 2009; 208 (5): 989–94.
27. Ivashkin, V.T., Shifrin O.S., Sokolina I.A. i dr. Steatoz podzheludochnoi zhelezy i ego klinicheskoe znachenie. Ros. zhurn. gastroenterologii, gepatologii, koloproktologii. 2006; 16 (4): 32–7. [in Russian]
28. Feigelson J, Pecau Y, Poquet M et al. Imaging changes in the pancreas in cystic fibrosis: a retrospective evaluation of 55 cases seen over a period of 9 years. J Pediatr Gastroenterol Nutr 2000; 30 (2): 145–51.
29. Kim KH, Kim CD, Ryu HS et al. Endoscopic retrograde pancreatographic findings of pancreatic lipomatosis. J Korean Med Sci 1999; 14 (5): 578–81.
30. Korochina I.E. Gastroenterologicheskie aspekty metabolicheskogo sindroma. Ros. zhurn. gastroenterologii, gepatologii, koloproktologii. 2008; 1 (1): 26–37. [in Russian]
31. Reuss J, Rettenmaier G. Transabdominal ultrasonography in pancreatic diseases. Schweiz Med Wochenschr 1993; 29, 123 (21): 1049–58.
32. Opacic M, Rustemovic N, Pulanic R et al. Percutaneous pancreatography under ultrasonographic guidance. 1996; 37 (l): 75–8.
33. Fadeenko G.D., Prosolenko K.A., Dubrov K.Iu. Steatoz podzheludochnoi zhelezy v ramkakh metabolicheskogo sindroma: uravnenie so mnogimi neizvestnymi. Vestn. kluba pankreatologov. 2010; 1: 21–5. [in Russian]
34. Вaggio L, Drucker D. Biologyofincretins: GLP-1 and GIP. Gastroenterology 2007; 132: 2131–57.
2. Коротько Г.Ф. Секреция поджелудочной железы. Краснодар: Изд-во Кубанского медицинского университета, 2005. / Korot'ko G.F. Sekretsiia podzheludochnoi zhelezy. Krasnodar: Izd-vo Kubanskogo meditsinskogo universiteta, 2005. [in Russian]
3. Gorelick F, Pandol, SJ, Topazian M. Pancreatic physiology, pathophysiology, acute and chronic pancreatitis. Gastrointestinal Teaching Project, American Gastroenterologic Association. 2003.
4. Keller J, Layer P, Johnson CD et al. Acinarislet interactions: Pancreatic exocrine insufficiency in diabetes mellitus: Pancreatic disease: Basic science and clinical management. Eds. C.D.Johnson, C.W.Imrie et al. London, 2004; 21: 267–78.
5. Pandol SJ. The Exocrine Pancreas. University of California. Morgan&Claypool Life Sciences, 2010.
6. http://www.uptodate.com/contents/insulin-secretion-and-pancreatic-beta-cell-function?source=search_r...
7. Петунина Н.А., Трухина Л.В., Синицына Е.И., Шестакова М.В. Глюкагон и a-клетки – новая терапевтическая мишень в лечении сахарного диабета. Сахарный диабет. 2013; 3: 35–40. / Petunina N.A., Trukhina L.V., Sinitsyna E.I., Shestakova M.V. Gliukagon i a-kletki – novaia terapevticheskaia mishen' v lechenii sakharnogo diabeta. Sakharnyi diabet. 2013; 3: 35–40. [in Russian]
8. Дедов И.И., Шестакова М.В. Сахарный диабет: диагностика, лечение, профилактика. 2011; с. 42–57. / Dedov I.I., Shestakova M.V. Sakharnyi diabet: diagnostika, lechenie, profilaktika. 2011; s. 42–57. [in Russian]
9. Быков В.Л. Частная гистология человека. СПб.: СОТИС, 2007; с. 113–7. / Bykov V.L. Chastnaia gistologiia cheloveka. SPb.: SOTIS, 2007; s. 113–7. [in Russian]
10. Дедов И.И., Яшков Ю.И., Ершова Е.В. Инкретины и их влияние на течение сахарного диабета 2 типа у пациентов с морбидным ожирением после бариатрических операций. Ожирение и метаболизм. 2012; 2: 5–7. / Dedov I.I., Iashkov Iu.I., Ershova E.V. Inkretiny i ikh vliianie na techenie sakharnogo diabeta 2 tipa u patsientov s morbidnym ozhireniem posle bariatricheskikh operatsii. Ozhirenie i metabolizm. 2012; 2: 5–7. [in Russian]
11. Schaefer JH. The normal weight of the pancreas in the adult human being: A biometric study. Anat Rec 1926; 32: 119–32.
12. Ogilvie, R.F. A quantitative estimation of the pancreatic islet tissue. Q J Med 1937; 6: 287–300.
13. Olsen TS. Lipomatosis of the pancreas in autopsy material and its relation to age and overweight. Acta Path Microbiol Scand 1978. Sect. A; 86: 367–73.
14. Mathur A, Marine M, Lu D et al. Nonalcoholic fatty pancreas disease. HPB 2007; 9: 312–8.
15. Gullo L, Salizzoni E, Serra C et al. Can pancreatic steatosis explain the finding of pancreatic hyperenzymemia in subjects with dyslipidemia? Pancreas 2006; 33 (4): 351–3.
16. Hsieh PS, Chan JY, Shyu JF et al. Mild portal endotoxinemia induces subacute hepatic inflammation and pancreatic beta-cell dysfunction in rats. Eur J Clin Invest 2008; 38 (9): 640–8.
17. Van Geenen E-J, Smits MM, Schreuder TC et al. Nonalcoholic Fatty Liver Disease Is Related to Nonalcoholic Fatty Pancreas Disease. Pancreas 2010; 39 (Issue 8): 1185–90.
18. Лазебник Л.Б., Звенигородская Л.А. Метаболический синдром и органы пищеварения. М.: Анахарсис, 2009. / Lazebnik L.B., Zvenigorodskaia L.A. Metabolicheskii sindrom i organy pishchevareniia. M.: Anakharsis, 2009. [in Russian]
19. Губергриц Н.Б., Казюлин А.Н. Метаболическая панкреатология. Донецк, 2011. / Gubergrits N.B., Kaziulin A.N. Metabolicheskaia pankreatologiia. Donetsk, 2011. [in Russian]
20. Fain JN, Madan AK, Hiler ML et al. Comparison of the release of adipokines by adipose tissue, adipose tissue matrix, and adipocytes from visceral and subcutaneous abdominal adipose tissues of obese humans. Endocrinology 2004; 145: 2273–82.
21. Cai D, Yuan D, Frantz F et al. Local and systemic insulin resistance resulting from hepatic activation of IKK-beta and NF-kappaB. Nat Med 2005; 11: 183–90.
22. Arkan MC, Hevener AL, Greten FR et al. IKK-beta links inflammation of obesity-related insulin resistance. Nat Med 2005; 11: 191–8.
23. Misu H, Ishikura K, Kurita S et al. Inverse Correlation between Serum Levels of Selenoprotein P and Adiponectin in Patients with Type 2 Diabetes. PLoS ONE 2012; 7 (4): 349–52.
24. Fantuzzi G, Mazzone T. Adipose tissue and atherosclerosis: Exploring the connection. Arteriosc Thromb Vasc Biol 2007; 27: 996–1003.
25. Шифрин О.С. Особенности лечебной тактики у больных хроническим панкреатитом среднетяжелого течения различной этиологии. Дис. … д-ра мед. наук. М., 2008. / Shifrin O.S. Osobennosti lechebnoi taktiki u bol'nykh khronicheskim pankreatitom srednetiazhelogo techeniia razlichnoi etiologii. Dis. … d-ra med. nauk. M., 2008. [in Russian]
26. Mathur A, Zyromski NJ, Pitt HA et al. Pancreatic Steatosis Promotes Dissemination and Lethality of Pancreatic Cancer. J Am Col Surg 2009; 208 (5): 989–94.
27. Ивашкин, В.Т., Шифрин О.С., Соколина И.А. и др. Стеатоз поджелудочной железы и его клиническое значение. Рос. журн. гастроэнтерологии, гепатологии, колопроктологии. 2006; 16 (4): 32–7. / Ivashkin, V.T., Shifrin O.S., Sokolina I.A. i dr. Steatoz podzheludochnoi zhelezy i ego klinicheskoe znachenie. Ros. zhurn. gastroenterologii, gepatologii, koloproktologii. 2006; 16 (4): 32–7. [in Russian]
28. Feigelson J, Pecau Y, Poquet M et al. Imaging changes in the pancreas in cystic fibrosis: a retrospective evaluation of 55 cases seen over a period of 9 years. J Pediatr Gastroenterol Nutr 2000; 30 (2): 145–51.
29. Kim KH, Kim CD, Ryu HS et al. Endoscopic retrograde pancreatographic findings of pancreatic lipomatosis. J Korean Med Sci 1999; 14 (5): 578–81.
30. Корочина И.Э. Гастроэнтерологические аспекты метаболического синдрома. Рос. журн. гастроэнтерологии, гепатологии, колопроктологии. 2008; 1 (1): 26–37. / Korochina I.E. Gastroenterologicheskie aspekty metabolicheskogo sindroma. Ros. zhurn. gastroenterologii, gepatologii, koloproktologii. 2008; 1 (1): 26–37. [in Russian]
31. Reuss J, Rettenmaier G. Transabdominal ultrasonography in pancreatic diseases. Schweiz Med Wochenschr 1993; 29, 123 (21): 1049–58.
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Авторы
Л.А.Звенигородская, Н.Э.Хачатурян*
ГБУЗ Московский клинический научно-практический центр Департамента здравоохранения г. Москвы. 111123, Россия, Москва, ш. Энтузиастов, д. 86
*nane18@list.ru
ГБУЗ Московский клинический научно-практический центр Департамента здравоохранения г. Москвы. 111123, Россия, Москва, ш. Энтузиастов, д. 86
*nane18@list.ru
________________________________________________
L.A.Zvenigorodskaya, N.E.Khachaturyan*
Moscow Clinical Science-Practical Center of the Department of Health of Moscow. 111123, Russian Federation, Moscow, sh. Entuziastov, d. 86
*nane18@list.ru
Moscow Clinical Science-Practical Center of the Department of Health of Moscow. 111123, Russian Federation, Moscow, sh. Entuziastov, d. 86
*nane18@list.ru
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