中国实用外科杂志

中国实用外科杂志 ›› 2009, Vol. 29 ›› Issue (05): 428-430.

• 论著 • 上一篇    下一篇

择期腹部手术后胰岛素抵抗相关因素研究

陈 宏a ,李 非a ,贾建国a ,薛纪秀b ,张淑文c   

  1. 首都医科大学宣武医院 a.普外科 b.麻醉科 c.外科实验室， 北京100053
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2009-05-13 发布日期:2009-05-13

  • Received:1900-01-01 Revised:1900-01-01 Online:2009-05-13 Published:2009-05-13

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摘要：

目的 研究腹部择期手术后发生胰岛素抵抗（IR）的相关因素，探讨IR的作用部位。方法 选择首都医科大学宣武医院2006年3月至2006年6月间腹部择期手术病人14例，其中男性5例，女性9例。分别检测病人术前1d（术前）、术中、术后第1天（术后）血浆肿瘤坏死因子α（TNF-α）、白介素6（IL-6）、血糖（BG）、血胰岛素 ( INS)，利用稳态模式评估法（HOMA） 计算胰岛素抵抗指数(HOMA-IR)、胰岛素分泌指数（HOMA-β） 和胰岛素敏感指数（ISI）。用逆转录聚合酶链反应（RT-PCR）方法，检测肌肉组织中胰岛素受体（INSR）、葡萄糖载体4（GLUT4）的基因表达。结果 术中和术后的BG、INS、IL-6和TNF-α分别呈进行性增加，其差异具有统计学意义（均为P<0.001）。术后HOMA-IR明显高于术前，差异具有统计学意义（P<0.001）；术后HOMA-β高于术前，但差异无统计学意义（P =0.103）。手术结束时腹直肌的GLUT4 mRNA 表达较手术开始有显著下降（P <0.001）,而INSR mRNA 表达却无明显差异（P =0.165）。ISI与手术时间（r=-0.736、P <0.001）、术中出血（r=-0.594、P =0.032）、术后TNF-a水平（r=-0.641、P =0.018）呈负相关。结论 腹部择期手术病人存在IR。IR的主要作用部位在受体后。缩短手术时间、降低手术创伤强度、减少出血对减轻IR具有重要意义。

关键词: 胰岛素抵抗, 稳态模式评估法, 葡萄糖载体4, 腹部手术

Abstract:

Clinical study of insulin resistance for patients after selective abdominal surgery CHEN Hong*, LI Fei , JIA Jian-guo, et al. *Department of General Surgery, Xuan Wu Hospital of Capital Medical University, Beijing 100053, China Corresponding author: CHEN Hong, E-mail: chenhong@medmail.com.cn Abstract Objective To investigate the risk factors of insulin resistance(IR) after selective abdominal surgery and the mechanism of IR induced by surgery. Methods Fourteen-patients including five male and nine female after selective abdominal surgery between March 2006 and June 2006 at Xuan Wu Hospital of Capital Medical University were studied. Fasting blood glucose, fasting plasma insulin, plasma TNF-α and IL-6 were tested for selective surgery patients on one day before, during and one day after surgery. Insulin resistance index (HOMA-IR) and the index of insulin secretion (HOMA-β) were calculated with homeostasis model assessment (HOMA). Insulin receptor and GLUT4 mRNA expression in skeletal muscle were assessed before and at the end of operation. Results Significant differences were found in fasting blood glucose, fasting plasma insulin, plasma TNF-α and IL-6 of pre-operative 1 day, during operation and post-operative 1 day (P <0.001). A significant elevation of HOMA-IR level was found on post-operative 1 day compared to that before surgery in all patients (P <0.001). However there was no significant difference in HOMA-β among the same two points of time (P=0.103). The result of RT-PCR showed that the expression of GLUT4 mRNA in muscle of patients at the end of operation reduced significantly compared with preoperation (P<0.001). ISI showed negative correlation with operative time(r=-0.736,P <0.001), blooding during operating (r=-0.594,P=0.032) and post-operative TNF-α(r=-0.641,P =0.018). R2 of the equation was 0.687. Conclusion Insulin resistance occurs in selective abdominal surgery patients. The defective site was at postreceptor, and the decrease of content and action of GLUT4 may play an important role in its mechanism. To control the intensity of surgery is helpful for decreasing IR.

Key words: insulin resistance, glucose transporter 4；homeostasis model assessment, abdominal surgery