恶性消化道肿瘤晚期患者血TNF-α与胰岛素抵抗和胰岛素分泌的功能关系

Relations of plasma TNF-α with insulin resistance and insulinexcretion in terminal patients with malignant gastrointestinal tumor

目的:证明恶性消化道肿瘤晚期患者血浆肿瘤坏死因子α(TNF-α)与胰岛素抵抗和胰岛素分泌功能相关性,阐明恶性消化道肿瘤晚期患者糖代谢障碍机制.方法:测定40例恶性消化道肿瘤晚期患者和40例正常人员血浆TNF-α和空腹血糖、胰岛素、乳酸含量,并计算稳态模式评估法胰岛素抵抗指数(HOMA-IR)和胰岛素分泌指数(HOMA-β).结果:恶性消化道肿瘤晚期患者血浆TNFα、空腹血糖、空腹胰岛素、空腹乳酸、HOMA-IR和HOMA-β均明显高于正常对照组(3.27±0.92vs1.23±0.36,P<0.01;5.19±0.75vs4.05±0.28,P<0.01;14.24±6.52vs8.27±4.84,P<0.01;7.11±0.69vs3.27±0.41,P<0.01;3.48±0.85vs1.55±0.77,P<0.01;181±39vs326±47,P<0.01),但空腹血糖仍在正常参考范围内.恶性消化道肿瘤晚期患者血TNFα与空腹血糖、空腹胰岛素、空腹乳酸明显正相关(r=0.4352,P<0.05;r=0.3136,P<0.05;r=0.7893,P<0.01),与HOMA-IR明显正相关(r=0.6531,P<0.01),与HOMA-β明显负相关(r=-0.5874,P<0.01).结论:恶性消化道肿瘤晚期患者血浆TNFα在胰岛素抵抗和胰岛素分泌功能下降及糖代谢障碍中发挥重要作用.

AIM： To explore the relations of plasma TNF-α with insulin resistance and insulin excretion in the disorder of glucose metabolism in the terminal patients with enteron malignant tumor. METHODS： The levels of the fasting glucose, insulin, lactic acid, postprandial glucose, lactic acid were measured in 40 terminal patients with enteron malignant tumor as well as in 40 normal controls, and the homeostasis model assessment of insulin resistance （HOMA-IR） and HOMA-β were calculated. RESULTS： The levels of the plasma TNF-α, the fasting glucose, insulin and lactic acid, and the values of HOMA-IR and HOMA-β in the terminal patients with enteron malignant tumor were significantly higher than those in the controls （3.27±0.92 vs 1.23±0.36, P 〈0.01 ; 5.19±0.75 vs 4.05±0.28, P 〈0.01; 14.24±6.52 vs 8.27±4.84, P 〈0.01; 7.11±0.69 vs 3.27±0.41, P 〈0.01; 3.48±0.85 vs 1.55±0.77, P 〈0.01 ; 181±39 vs 326±47, P 〈0.01）, but the content of the fasting glucose was in normal range. The level of the plasma TNF-α was positively correlated with the contents of the fasting glucose, insulin and lactic acid and the value of HOMA- IR （r = 0.4352, P 〈0.05; r = 0.3136, P 〈0.05; r = 0.7893, P 〈0.01 ; r = 0.6531, P 〈0.01）, but negatively correlated with the value of HOMA-β in terminal patients with enteron malignant tumor （r = -0.5874, P 〈0.01）. CONCLUSION： The plasm TNF-α plays an important role in the insulin resistance, the hyposecretion of insulin and the disorder of glucose-metabolism in the terminal patients with malignant gastrointestinal tumor.