Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark.
Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
Front Endocrinol (Lausanne). 2024 Nov 8;15:1395686. doi: 10.3389/fendo.2024.1395686. eCollection 2024.
Acute severe ulcerative colitis (ASUC) is characterized by systemic inflammation, which may initiate an acute-phase response leading to hypercatabolism. Patients with ASUC are usually treated with high-dose steroids that may further accelerate the metabolic response and lead to hyperglycemia and insulin resistance. Nevertheless, the degree of synergy between inflammation and steroid treatment and their influence on the insulin resistance remains unknown. We aimed to measure the degree of metabolic stress including insulin resistance in patients with ASUC during admission and three weeks after discharge.
This single-center cohort study was conducted in adult patients with ASUC, defined and assessed by Truelove and Witt's criteria. Indirect calorimetry, bioelectrical impedance analysis, and the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) were applied at baseline and at follow-up three weeks after discharge.
Among the 22 patients admitted during the project period, 15 provided consent for participation in the study. Median C-reactive protein at inclusion was 37.6 [4; 154.7]. Both median HOMA-IR and fasting plasma glucose were markedly increased at inclusion (median 8.6 [3.8; 14.1] and 7.1 [6; 8.7], respectively), and both had decreased significantly three weeks after discharge (p=0.0036 and p=0.0039, respectively). No significant differences were observed in resting energy expenditure or anthropometric measurements from baseline to follow-up.
Patients with ASUC presented with marked insulin resistance, indicating that the days following admission and high-dose steroid treatment are particularly vulnerable. Despite improvement at three-week follow-up, patients still exhibited insulin resistance compared with relevant control groups.
ClinicalTrials.gov, identifier NCT0527183.
急性重度溃疡性结肠炎（ASUC）的特征是全身炎症，这可能引发急性相反应，导致分解代谢亢进。ASUC 患者通常接受大剂量类固醇治疗，这可能进一步加速代谢反应，导致高血糖和胰岛素抵抗。然而，炎症和类固醇治疗之间的协同程度及其对胰岛素抵抗的影响尚不清楚。我们旨在测量 ASUC 患者入院时和出院后 3 周时的代谢应激程度，包括胰岛素抵抗。
这项单中心队列研究纳入了符合特鲁尔夫和维特标准定义和评估的 ASUC 成年患者。入院时和出院后 3 周时分别应用间接热量测定法、生物电阻抗分析和稳态模型评估的胰岛素抵抗（HOMA-IR）进行测量。
在项目期间入院的 22 名患者中，有 15 名同意参与研究。纳入时的中位 C 反应蛋白为 37.6[4；154.7]。纳入时的中位 HOMA-IR 和空腹血糖均明显升高（中位数分别为 8.6[3.8；14.1]和 7.1[6；8.7]），出院后 3 周时均显著降低（p=0.0036 和 p=0.0039）。从基线到随访，静息能量消耗或人体测量学测量值无显著差异。
ASUC 患者存在明显的胰岛素抵抗，表明入院后和大剂量类固醇治疗期间特别容易出现这种情况。尽管在 3 周随访时有所改善，但与相关对照组相比，患者仍存在胰岛素抵抗。
ClinicalTrials.gov，标识符 NCT0527183。
