Böbrek nakli sonrası magnezyum düzeyindeki değişikliklerin glukoz metabolizması üzerine etkisinin incelenmesi
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Date
2019-06-14
Authors
Oflaz, Rafet
Journal Title
Journal ISSN
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Publisher
Bursa Uludağ Üniversitesi
Abstract
Bu çalışmada, böbrek nakli sonrası magnezyum ile glukoz ve insülin düzeylerindeki değişiklikler arasındaki ilişki ve immünsüpresif ilaçların bu parametreler üzerine etkisi araştırılmıştır. Böbrek nakli yapılan 38 hasta (14 kadın, 24 erkek) çalışmaya dahil edildi. Üç aylık dönemde magnezyum (Mg+2), glukoz, insülin ve insülin direnci (HOMA-IR) ölçüldü. Hastalar iki gruba bölündü (takrolimus-TAC ve siklosporin-CsA). Tüm hastalarda bazale göre post-op serum Mg+2 değerleri anlamlı azaldı, ancak post-op 1 ve 3. ay değerleri arasında fark yoktu. CsA ve TAC gruplarında pre-op değerler ile karşılaştırıldığında Mg+2 değerleri anlamlı düştü. TAC grubundaki post-op 1. ay ve 3. ayda Mg+2 düzeylerindeki azalma CsA grubundan daha fazlaydı. Hipomagnezemi sıklığı pre-op %5,3, 1. ayda %81,6 ve 3. ayda %78,9 bulundu. Post-op 3. ayda hipomagnezemi oranı TAC grubunda (%85,5), CsA (%58,3) grubundan daha yüksekti (p=0,034). Post-op insulin ve HOMA-IR değerleri anlamlı artar iken açlık kan glukozu anlamlı değişmedi. Sadece TAC grubunda serum insulin, açlık kan glukozu ve HOMA-IR değerleri, pre-op ile karşılaştırıldığında post-op 3. ayda anlamlı daha yüksekti. CsA grubuyla karşılaştırıldığında TAC grubunda post-op 3. ay glukoz değerleri (-%7,2'ye karşılık %8,4, p=0,046) daha anlamlı arttı. Ancak CsA ve TAC gruplarında post-op 3. ayda insülin ve HOMA-IR değerlerindeki değişiklikler benzerdi. İnsülin direnci olan hasta sayısı TAC grubunda nakil öncesi %11,5'ten, BN sonrası %50'ye yükseldi. CsA grubunda ise %50'den %33,3'e düştü. Sonuç olarak çalışmamızda böbrek nakli sonrası hiperglisemi, insülin direnci artışı ve hipomagnezemi sıklığı artmaktadır. Hipomagnezemik etki TAC ile daha belirgindir. Böbrek nakli sonrası hiperglisemi, insülin direnci artışı ve hipomagnezemi TAC kullanımı ile ilişkili olabilir.
In this study we aimed to investigate the correlation between the post op magnesium levels and the changes in the levels of the glucose and insulin after the kidney transplantation; and the effects of the immunsupresive drugs to these parameters. Study included 38 patients (14 women, 24 men) who have undergone a kidney transplantation. Patients' Mg, glucose, insulin and insulin resistance (HOMA-IR) levels had been measured and recorded for 3 months. Patients were divided into two groups (Tacrolimus-TAC and Siklosporin-CsA). The Mg levels of all patients signaficantly decreased in compared to basal serum levels of Mg. On the other hand there are no differences between the levels of the first and third month measures. The magnesium levels of the CsA and TAC groups signaficantly decreased in compared to their pre op measures. The decrease of the TAC group post op serum Mg level measures in the first month and the third month were greater than the decrease in the levels of the CsA group. Frequency of hypomagnesemia were detected as 5.3% in pre-op measures, in the first month as 81.6%, in the third month as 78.9%. TAC group's the third month post-op hypomagnesemia ratio (85.5%) was greater than CsA group's ratio (58.3) (p=0.034) Significant increases were detected on post-op İnsulin and Homeostasis model assesment insulin resistance (HOMA-IR) values, but there were not meaningfull changes in prepirandial blood glucose levels. Only TAC group's serum insulin, Prepirandial blood glocose level and HOMA-IR values were significantly increased in the post-op third month in comparison with the pre-op values. TAC group's post-op third month glucose levels were signaficantly increased in compared to CsA group (-7.2% to 8.4%, p=0.046). But, the changes of both two groups' insulin and HOMA-IR levels in the third month were similar. The number of patients with insulin resistance in TAC group increased from 11.5% (preop) to 50% (post op). On the other hand, the number of the CsA group patients with insulin resistance decreased from 50% to 33.3%. İn conclusion, frequency of hyperglisemia, İnsulin resistance and hypomagnesimia were increased after kidney transplantation. Hypomagnesimia was observed to be more common in TAC group than CsA group. According to our study, increase in frequency of hyperglisemia, İnsulin resistance and hypomagnesimia after the kidney transplatation could be related with Tacralimus use.
In this study we aimed to investigate the correlation between the post op magnesium levels and the changes in the levels of the glucose and insulin after the kidney transplantation; and the effects of the immunsupresive drugs to these parameters. Study included 38 patients (14 women, 24 men) who have undergone a kidney transplantation. Patients' Mg, glucose, insulin and insulin resistance (HOMA-IR) levels had been measured and recorded for 3 months. Patients were divided into two groups (Tacrolimus-TAC and Siklosporin-CsA). The Mg levels of all patients signaficantly decreased in compared to basal serum levels of Mg. On the other hand there are no differences between the levels of the first and third month measures. The magnesium levels of the CsA and TAC groups signaficantly decreased in compared to their pre op measures. The decrease of the TAC group post op serum Mg level measures in the first month and the third month were greater than the decrease in the levels of the CsA group. Frequency of hypomagnesemia were detected as 5.3% in pre-op measures, in the first month as 81.6%, in the third month as 78.9%. TAC group's the third month post-op hypomagnesemia ratio (85.5%) was greater than CsA group's ratio (58.3) (p=0.034) Significant increases were detected on post-op İnsulin and Homeostasis model assesment insulin resistance (HOMA-IR) values, but there were not meaningfull changes in prepirandial blood glucose levels. Only TAC group's serum insulin, Prepirandial blood glocose level and HOMA-IR values were significantly increased in the post-op third month in comparison with the pre-op values. TAC group's post-op third month glucose levels were signaficantly increased in compared to CsA group (-7.2% to 8.4%, p=0.046). But, the changes of both two groups' insulin and HOMA-IR levels in the third month were similar. The number of patients with insulin resistance in TAC group increased from 11.5% (preop) to 50% (post op). On the other hand, the number of the CsA group patients with insulin resistance decreased from 50% to 33.3%. İn conclusion, frequency of hyperglisemia, İnsulin resistance and hypomagnesimia were increased after kidney transplantation. Hypomagnesimia was observed to be more common in TAC group than CsA group. According to our study, increase in frequency of hyperglisemia, İnsulin resistance and hypomagnesimia after the kidney transplatation could be related with Tacralimus use.
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Keywords
Böbrek nakli, Hipomagnezemi, Kalsinörin inhibitörü, İnsülin direnci, Diabetes mellitus, Kidney transplantation, Hypomagnesemia, Calcineurin inhibitor, Insulin resistance, Diabetes mellitus
Citation
Oflaz, R. (2019). Böbrek nakli sonrası magnezyum düzeyindeki değişikliklerin glukoz metabolizması üzerine etkisinin incelenmesi. Yayınlanmamış yüksek lisans tezi. Bursa Uludağ Üniversitesi Sağlık Bilimleri Enstitüsü.