L-精氨酸对体外循环中胰岛素抵抗及炎性反应因子的影响

The influence of L arginine on insulin resistance during cardiopulmonary bypass and the effects of inflammatory factors

目的探讨左旋精氨酸(L-Arg)对体外循环(CPB)下机体在缺血再灌注损伤后胰岛素抵抗的缓解作用。方法40例CPB下行心脏瓣膜置换术患者随机分成对照组和治疗组,分别于麻醉前(T0)、CPB 15 min(T1)、开放升主动脉后15 min(T2)和停CPB后2 h(T3)测定血浆血糖、胰岛素、血浆肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、白细胞介素8(IL-8)水平,计算胰岛素敏感指数(ISI)和胰岛素抵抗指数对数Lg MOHA。结果两组组间比较显示T2、T3各指标较体外循环前T0、T1升高,差异有统计学意义(P<0.05);两组T1较体外循环前T0升高,差异有统计学意义(P<0.05)。两组组间比较显示T1、T0各指标比较差异无统计学意义;两组T2、T3各指标比较有统计学意义(P<0.05)。TNF-α、IL-6、IL-8与ISI相关分析显示具有负相关关系,TNF-α、IL-6、IL-8与Lg-HOMA相关分析显示具有正相关关系。结论CPB期间存在明显的胰岛素抵抗现象;L-Arg可改善术中胰岛素抵抗的程度。

Objective To investigate the influence of L arginine on cardiopulmonary bypass （CPB） under the body at postischemia reperfusion injury in the role of insulin resistance mitigation. Methods 40 cases of proceding CPB in patients with cardiac valve replacement were randomly divided into control group and treatment group respectively, before anesthesia （T0）, CPB 15 min （T1）, after opening the ascending aorta 15 min （T2） and stopped two hours after CPB （T3） plasma glucose, insulin, TNF-α, IL-6, IL-8 level,and insulin resistance index （IRI） was calculated. Results Inner-group comparison suggested the indicators of T2,T3 of the two groups before cardiopulmonary bypass were significantly higher than that of T0, T1 （P〈0.05） ;T1 of the two groups was higher than that of TO before cardiopulmonary bypass, and the difference was statistically significant （P〈0.05）. Inter-group compari son showed the indicators of Tland TO in the two groups had no significant difference; the indicator of T2 and T3 showed the more significance （P〈0.05）. TNF-α, IL-6, IL-8 with the ISI-related analysis showed the negative correlation. TNF-α, IL-6, IL-8 and the LGHOMA-related analysis showed a positive correlation. Conclusion During CPB there is an obvious phenomenon of insulin resistance; L-arginine can improve the degree of insulin resistance.