ssmuБюллетень сибирской медициныBulletin of Siberian Medicine1682-03631819-3684Siberian State Medical University, the Ministry of Healthcare of the Russian Federation10.20538/1682-0363-2013-3-132-147ssmu-350Research ArticleОБЗОР ЛИТЕРАТУРЫLITERATURE REVIEWПАНКРЕАТИЧЕСКИЕ И ЭКСТРАПАНКРЕАТИЧЕСКИЕ ЭФФЕКТЫ ИНКРЕТИНОВ И ПЕРСПЕКТИВЫ ИЗУЧЕНИЯ ЭНТЕРОИНСУЛЯРНОЙ ГОРМОНАЛЬНОЙ СИСТЕМЫ У БЕРЕМЕННЫХ ЖЕНЩИН ПРИ ГЕСТАЦИОННОМ НАРУШЕНИИ УГЛЕВОДНОГО ОБМЕНАPANCREATIC AND EXTRA-PANCREATIC EFFECTS OF INCRETINS AND PERSPECTIVES FOR STUDYING ENTEROINSULIN HORMONAL SYSTEM DURING GESTATIONAL DISORDER OF CARBOHYDRATE METABOLISMСапринаТ. В.SaprinaT. V.

Саприна Татьяна Владимировна – кандидат медицинских наук, доцент кафедры эндокринологии и диабетологии

tvsaprina@sibmail.comТимохинаЕ. С.TimokhinaYe. S.

Тимохина Екатерина Сергеевна – аспирант кафедры эндокринологии и диабетологии

tvsaprina@sibmail.comМусинаН. Н.MusinaN. N.

Мусина Надежда Нурлановна – студентка 4-го курса лечебного факультета

tvsaprina@sibmail.comПрохоренкоТ. С.ProkhorenkoT. S.

Прохоренко Татьяна Владимировна – ассистент кафедры молекулярной медицины и клинической лабораторной диагностики

tvsaprina@sibmail.comТаширеваЛ. А.TashirevaL. A.

Таширева Любовь Александровна – аспирант кафедры патологической физиологии

tvsaprina@sibmail.comГончаревичО. К.GoncharevichO. K.

Гончаревич Ольга Константиновна – врач-эндокринолог

Goncharevich Olga K.

tvsaprina@sibmail.comСибирский государственный медицинский университет, ТомскРоссияSiberian State Medical University, TomskRussian FederationТомская больница ФГУ «Сибирский окружной медицинский центр» Минздрава России, ТомскРоссияTomsk Hospital of FSU „Siberian Regional Medical Center“ of Healthcare of Russia, TomskRussian Federation201328062013123132147Copyright © Саприна Т.В., Тимохина Е.С., Мусина Н.Н., Прохоренко Т.С., Таширева Л.А., Гончаревич О.К., 20132013Саприна Т.В., Тимохина Е.С., Мусина Н.Н., Прохоренко Т.С., Таширева Л.А., Гончаревич О.К.Saprina T.V., Timokhina Y.S., Musina N.N., Prokhorenko T.S., Tashireva L.A., Goncharevich O.K.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://bulletin.ssmu.ru/jour/article/view/350

Отсутствие идеального препарата для лечения больных сахарным диабетом 2-го типа (СД-2), который сможет обеспечить не только качественный и постоянный контроль уровня гликемии без увеличения массы тела, риска развития гипогликемии, негативного влияния на сердце, почки, печень, но и обеспечит сохранение секреторной функции β-клеток, заставляет ученых продолжать поиски новых возможностей воздействия на причину возникновения и прогрессирования такой болезни, как СД-2. В поисках оптимального метода лечения СД-2 научные исследования были направлены на изучение принципиально нового механизма регуляции гомеостаза глюкозы посредством гормонов желудочно-кишечного тракта, называемых инкретинами.Гастроингибирующий пептид (ГИП) и глюкагоноподобный пептид-1 (ГПП-1) – два основных инкретина, вырабатываемых в кишечнике в ответ на поступление глюкозы или других нутриентов и стимулирующих секрецию инсулина β-клетками поджелудочной железы. Помимо инсулинотропных эффектов ГИП и ГПП-1 участвуют во многих биологических процессах, протекающих в различных тканях и органах, где представлены рецепторы ГИП и ГПП-1: в поджелудочной железе, жировой ткани, костной ткани и головном мозге. В поджелудочной железе ГИП и ГПП-1 стимулируют пролиферацию β-клеток и ингибируют их апоптоз, ГИП стимулирует выработку глюкагона в постпрандиальном периоде, тогда как ГПП-1 ее угнетает. ГИП способствует отложению жировой ткани, а также стимулирует костеобразование, в то время как ГПП-1 ингибирует резорбцию кости. В центральной нервной системе ГИП и ГПП-1 вовлечены в процессы формирования памяти и контроль аппетита. Секреция ГИП и ГПП-1 и их инсулинотропные эффекты различаются у больных СД 2-го типа в сравнении со здоровыми людьми.Наименее изучена роль энтероинсулярных гормонов в развитии гестационных нарушений углеводного обмена.В обзорной статье приведен анализ публикаций, обобщающий известные данные о панкреатических и экстрапанкреатических эффектах ГИП и ГПП-1 в сравнении у здоровых лиц и пациентов с СД-2. Также рассмотрены аспекты патофизиологии гестационного диабета и перспективы изучения энтероинсулярных гормонов у беременных женщин.

The absence of an ideal medicine for the treatment of patients with type 2 diabetes, that would be able to provide not only high quality and constant monitoring of glycemia without increasing body weight, with no risk of hypoglycemia, with no negative impact on the heart, kidneys, liver, but could also ensure the preservation of the secretory function of β-cells, makes scientists continue to search for new opportunities to influence the occurrence and progression of T2D.Gastric inhibitory polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) are the two primary incretin hormones secreted from the intestine on ingestion of glucose or nutrients to stimulate insulin secretion from pancreatic β-cells. Within the pancreas, GIP and GLP-1 together promote β-cell proliferation and inhibit apoptosis, thereby expanding pancreatic β-cell mass, while GIP enhances postprandial glucagon response and GLP-1 suppresses it. In adipose tissues, GIP but not GLP-1 facilitates fat deposition. In bone, GIP promotes bone formation while GLP-1 inhibits bone absorption. In the brain, both GIP and GLP-1 are thought to be involved in memory formation as well as the control of appetite. In addition to these differences, secretion of GIP and GLP-1 and their insulinotropic effects on β-cells have been shown to differ in patients with type 2 diabetes compared to healthy subjects.Enteroinsulin hormones' role in the development of gestational disorder of carbohydrate metabolism is poorly understood.In a review article we analyze the publications that summarize what is known about the pancreatic and extra-pancreatic GIP and GLP-1-effects compared with healthy subjects and type 2 diabetes patients. The aspects of gestational diabetes pathophysiology and the perspectives for studying enteroinsulin hormonal system during pregnancy are also discussed in the article.

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