胰岛素强化治疗对胃癌根治术患者静息能量代谢的影响

Effect of intensive insulin therapy on resting energy expenditure in postoperative patients underwent radical distal gastrectomy

目的观察胰岛素强化治疗对胃癌根治术患者静息能量代谢的影响。方法选取2010年1月至10月拟接受胃癌根治术的胃中、下部癌患者64例，随机分为胰岛素强化治疗组和非胰岛素强化治疗组，使手术后血糖分别控制在4．4～6．1mmol／L和4．4—10．0mmol／L，应用间接能量测定仪监测术前和术后第1、3、7天的静息能量消耗（REE）、呼吸商（RQ）、每千克静息能量消耗（REE／k）和脂肪氧化供能比例的变化；测定空腹血中葡萄糖和胰岛素浓度评价胰岛素抵抗指数（HOMA-IR）的改变。结果与术前相比，两组术后第1、3天的REE、REE／kg、脂肪氧化供能比例、Ln—HOMA—IR水平明显增加（P〈0．05）；RQ明显下降（P〈0．05）。与非胰岛素强化治疗组相比，胰岛素强化治疗明显降低术后第1、3天的REE／kg水平[（27．2±1．3）kcal／kg比（30．0±1．5）kcal／kg，P=0．008；（24．7±1．4）kcal／kg比（25．7±1．6）kcal／kg，P=0．013]，降低术后第1、3天的Ln—HOMA—IR分数水平（P=0．019，0．028）和降低术后第1、3天的C反应蛋白的水平（P=0．017，0．006）。胰岛素强化治疗组术后总蛋白和白蛋白水平明显高于非强化治疗组（P=0．023，0．009）。结论胰岛素强化治疗具有降低术后静息能量消耗、减少蛋白质消耗和降低胰岛素抵抗的作用。

Objective To investigate the effect of intensive insulin therapy on resting energy expenditure in postoperative patients underwent radical distal gastrectomy. Methods Sixty-four patients with gastric neoplasms in the middle or lower part of stomach from January to October 2010 were enrolled and underwent radical distal gastrectomy,then were randomized to intensive insulin therapy （IIT） group to keep glucose levels from 4.4 to 6. 1 mmol/L or conventional insulin therapy（CIT） group to keep levels from 4.4 to 10. 0 mmol/L. Resting energy expenditure （REE）, respiratory quotient （RQ）, resting energy expenditure per kilogram（REE/kg） and lipid oxidation ratio （LOR） were monitored by indirect energy metabolic system on preoperative and postoperative 1^st ,3^rd and 7^th day. Fasting blood glucose and insulin concentration were measured for HOMA-IR assessment. Results Compared with preoperative baseline, postoperative REE, REE/kg, LOR, Ln-HOMA-IR increased dramatically（ P 〈 0.05, respectively）. RQ decreased markedly （P 〈 0. 05）. Compared with group CIT,IIT reduced the REE/kg level [ （27.2 ± 1.3） kcal/kg vs. （30. 0± 1.5） kcal/kg,P =0. 008 ; （24.7 ±1.4） vs. （25. 7 ±1.6） kcal/kg,P = 0. 013 ] ; and decreased the Ln-HOMA-IR score （P = 0. 019 and 0. 028） on postoperative 1^st and 3^rd day; IIT could decrease obviously the level of C-reaction protein level on postoperative 1 ^st and 3^rd day （P=0. 017,0. 006）. The total protein and albumin concentration in liT group were more than its levels in group CIT（ P = 0. 023,0. 009 ）. Conclusion There are some benefits of liT in reducing mean energy expenditure and the consumption of proteins, decreasing postoperative insulin resistance level in this small population underwent radical distal gastrectomy.