胰岛素强化治疗对胃癌术后胰岛素抵抗和血清蛋白的影响

Effects of intensive insulin therapy on insulin resistance and serum proteins after radical gastrectomy

目的探讨胃癌患者术后胰岛素强化治疗对胰岛素抵抗（IR）及血清蛋白的影响。方法将22例行根治性远端胃次全切除术的胃癌患者随机分为对照组（11例）和胰岛素强化治疗组（11例）。分别于术前和术后第1、3、7天测量空腹血糖（FBG）、胰岛素（FINS）和血清白蛋白、血清转铁蛋白（TRF）、前白蛋白（PRE）和视黄醇结合蛋白（RBP），使用稳态模式评估法（HOMA）计算IR指数（HOMA—IR），记录患者住院天数和术后并发症等。结果术后第1、3、7天，对照组和胰岛素强化治疗组IR发生率分别为54．55％和36．36％、9．09％和36．36％、18．18％和0，两组比较差异有统计学意义（P〈0．05）。胰岛素强化治疗组术后第1、3天FBG、FINS和InHOMA—IR明显低于对照组（P〈0．01，P〈0．05）；术后第7天TRF、PRE、RBP高于对照组（P〈0．05）；术后发热时间、抗生素使用时间、肛门排气时间和住院天数明显少于对照组（P〈0．01，P〈0．05），术后并发症发生率明显低于对照组（P〈0．05）。结论胰岛素强化治疗有利于降低胃癌患者术后IR发生率，改善患者的营养状态，防止术后并发症的发生。

Objective To investigate the effects of intensive insulin therapy on insulin resistance（IR） and serum proteins after radical gastrectomy. Methods Twenty-two gastric cancer patients were randomly divided into the control （n=11 ） and intensive insulin therapy group （n=11 ）, and underwent distal radical subtotal gastrectomy under epidural anesthesia. Fasting blood glucose （FBG）, fasting insulin （FINS） and serum proteins were assayed preoperatively and at day 1, 3, 7 postoperatively. Insulin resistance index was calculated using homeostasis model assessment （HOMA）. The length of hospital stay and postoperative complications were recorded respectively. Results （1）The levels of FBG, FINS, lnHOMA-IR （P〈0.01 ,P〈0.05） and the incidence of insulin resistance were remarkably decreased by intensive insulin therapy after the surgical procedure. （2）The levels of serum transferrin （TRF）, prealbumin （PRE） and retinal binding protein （RBP） in the intensive insulin therapy group were significantly improved as compared to control group after operation （P〈0.05）. （3） The duration of fever, antibiotic use, passage of gas by anus, length of hospital stay and the occurrence of postoperative complications were also significantly lower than those in control group （P〈0.01, P〈0.05）. Conclusion Compared to routine therapy, the intensive insulin therapy has more beneficial effects on the patients undergone distal radical subtotal gastrectomy in decreasing the insulin resistance, improving the status of nutrition and preventing postoperative complications.