胰岛素强化治疗对胃癌术后胰岛素抵抗的影响

THE EFFECT OF INTENSIVE INSULIN THERAPY ON INSULIN RESISTANCE AFTER RADICAL GASTRECTOMY

目的探讨胰岛素强化治疗对胃癌病人术后胰岛素抵抗的影响。方法将22例胃癌病人随机分为对照组和胰岛素强化治疗组（各11例），均在硬膜外麻醉下行根治性远端胃次全切除术，分别于术前和术后第1、3、7天测量空腹血糖（FBG）、胰岛素（FINS）、C-反应蛋白（CRP），使用稳态模式评估法（HOMA）计算胰岛素抵抗指数（HOMA—IR）。结果对照组和胰岛素强化治疗组FBG、FINS、lnHOMA—IR术前比较差异无显著性（t=0．162、0．546、0．342，P〉0．05）；术后第1、3天强化治疗组低于对照组，差异有显著性（t=2．186～6．293，P〈0．05）；对照组术后第1、3天FBG、FINS、lnHOMA—IR高于术前，差异有显著性（F=20．81、11．68、15．61，q=5．48-40．72，P〈0．05）。对照组和胰岛素强化治疗组CRP术前比较差异无显著性（t=0．676，P〉0．05）；术后强化治疗组低于对照组，差异有显著性（t=2．365-2．550，P〈0．05）；两组术后CRP高于术前，差异有显著性（F=106．52、117．90，q=59．28～158．83，P〈0．05）。结论胰岛素强化治疗能降低胃癌术后病人的胰岛素抵抗，减轻术后炎性反应。

Objective To study the influence of intensive insulin therapy （IIT） on insulin resistance after radical gastrectomy. Methods Twenty-two patients with gastric cancer were evenly divided into control and IIT group in random, all of them underwent distal radical subtotal gastrectomy under epidural anesthesia. Fasting blood glucose （FBG） and insulin （FINS） and C-reactive protein （CRP） levels were detected before and on 1st, 3rd and 7th day after surgery. Insulin resistance index was calculated using homeostasis model assessment （HOMA）. Results There was no significant difference of the levels of FBG, FINS and InHOMA-1R between IIT and contro group before surgery （t = 0.162,0. 546,0. 342 ;P〉0.05）, and a significant difference was noted between the two groups postoperatively, and the levels of FBG, FINS and InHOMA-IR IIT were lower than that of the controls. No significant difference was observed of the levels of CRP between the two groups, preoperatively, but postoperatively, CRP was lower for IIT. Conclusion Intensive insulin therapy may decrease insulin resistance and reduce inflammatory reaction after radical gastrectomy.