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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GLUT4mRNA表达较手术开始有显著下降(P<0.001),而INSRmRNA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。
Objective To study the related factors of insulin resistance (IR) after elective surgery in the abdomen and to explore the role of IR. Methods Xuanwu Hospital of Capital Medical University from March 2006 to June 2006 abdomen elective surgery in 14 patients, including 5 males and 9 females. The levels of TNF-α, IL-6, BG and GPI were measured at 1 day before operation, before and after operation, respectively. INS). HOMA-IR, HOMA-β and ISI were calculated by using HOMA. The gene expression of insulin receptor (INSR) and glucose transporter 4 (GLUT4) in muscle tissue was detected by reverse transcription-polymerase chain reaction (RT-PCR). Results The levels of BG, INS, IL-6 and TNF-α increased progressively and intraoperatively and postoperatively, respectively, with statistically significant differences (all P <0.001). Postoperative HOMA-IR was significantly higher than preoperative, the difference was statistically significant (P <0.001); postoperative HOMA-β was higher than preoperative, but the difference was not statistically significant (P = 0.103). The GLUT4 mRNA expression in the rectus abdominis was significantly lower than that at the beginning of surgery (P <0.001), while the expression of INSR mRNA was not significantly different at the end of surgery (P = 0.165). ISI was negatively correlated with operative time (r = -0.736, P <0.001), intraoperative bleeding (r = -0.594, P = 0.032) and postoperative TNF-a level (r = -0.641, P = 0.018). Conclusion There is IR in patients undergoing elective surgery. The main role of IR in the receptor site. Shorten the operation time, reduce the traumatic intensity and reduce the bleeding to reduce the IR is of great significance.