Ключові слова
інсулінорезистентність
ожиріння
збільшення індексу маси тіла
метформін
Як цитувати
Анотація
Актуальність. Вплив інсулінорезистентності щодо можливості збільшення ризику раку щитоподібної залози (РЩЗ) останнім часом привертає все більшу увагу науковців. Ця проблема все ще далека від остаточного розв’язання. Вивчення цього зв’язку може позначитися на ефективності лікування зазначеної розповсюдженої патології.
Мета роботи. Розглянути поточні літературні джерела, які висвітлюють дослідження взаємозв’язку між інсулінорезистентністю (ІР) та раком щитоподібної залози, а також можливі механізми такого зв’язку.
Матеріали та методи. Пошук літератури було здійснено ручним методом за ключовими словами (рак щитоподібної залози, інсулінорезистентність, інсуліноподібний фактор росту – 1 та 2 (ІФР-1, ІФР-2), абдомінальне ожиріння, збільшення індексу маси тіла, метформін), а також розглянуто літературні джерела з доказових баз даних PubMed, Web of Science. Брали до уваги метааналізи, систематичні огляди та когортні дослідження. Всього було опрацьовано 148 джерел літератури. Перевага була віддана джерелам, опублікованим за останні 10 років.
Результати та їх обговорення. Інсулінорезистентність розглядається як важливий незалежний чинник розвитку багатьох злоякісних новоутворень. Свою канцерогенну дію інсулінорезистентність чинить як самостійно, так і через пов’язані з нею метаболічні порушення. Встановлено, що надмірна маса тіла й ожиріння значною мірою пов’язані з більш агресивними клініко-патологічними ознаками РЩЗ. Недавні дослідження показали більший об’єм щитоподібної залози та вищий ризик утворення вузлів у пацієнтів з ІР. Вісь ІФР є одним з основних чинників трансформації щитоподібної залози. Терапевтичні підходи щодо усунення метаболічного синдрому й асоційованих із ним ендокринних порушень для профілактики та терапії онкологічних захворювань привертають все більший науковий інтерес. У дослідженнях продемонстровано протипухлинні властивості метформіну та його здатність гальмувати канцерогенез.
Висновки. Поданий аналіз літератури довів, що проблема лікування злоякісних новоутворень щитоподібної залози та їхнього метастазування зумовлена не тільки морфологічними, клінічними та молекулярно-біологічними особливостями самої пухлини, а й недостатніми відомостями щодо зв’язку інсулінорезистентності, абдомінального ожиріння, збільшення індексу маси тіла, висококалорійного раціону харчування та зменшення вживання поліненасичених жирів, шкідливого впливу довкілля з молекулярними змінами, специфічними для раку щитоподібної залози. Це підтверджується значним зростанням захворюваності на рак щитоподібної залози, особливо папілярного гістотипу, паралельно зі зростанням поширеності ожиріння. Особливу увагу приділяють вивченню можливостей зниження захворюваності та смертності від онкологічної патології при застосуванні засобів, які стабілізують інсулін та сприяють зменшенню ступеня гіперінсулінемії, одним із яких є метформін
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