吲哚美辛对胃肠道肿瘤患者术后胰岛素抵抗及代谢反应的影响

Effect of indomethacin on insulin resistance after operation and metabolic response to surgical injury in patients with gastrointestinal tumor

目的 观察吲哚美辛对胃肠道肿瘤患者术后胰岛素低抗及代谢反应的影响。方法 将58例胃癌、结肠癌患者采用信封法随机分为吲哚美辛组（n=28）和对照组（n=30），两组患者均在全身麻醉下行根治性子术治疗，术后24h给予肠外营养支持5～7d，吲哚美辛组术后每12小时给于吲哚美辛栓100mg。于术前和术后24、72、120h空腹抽血检测空腹血糖（FBG）、宁腹胰岛素（FINS）、肌酐（Cr）、血液尿素氮（BUN）、H油鼍脂（TG）、游离脂肪酸（FFA）和C-反应蛋白（CRP）浓度，并采用稳态模式评估法（HOMA）计算胰岛素抵抗指数（HOMA-IR）。观察术后72h内生命体征。结果吲哚美辛组术后牛命体征变化较小。术后24h、72h对照组FBG、FINS、lnHOMA—IR明显高于术前水平（P均=0．000），也明显高于吲哚美辛组（P均〈0．01）。两组患者术后血清Cr、BUN、TG和FFA水平均高于术前，但随时间呈下降趋势。吲哚美辛组术后120h各指标水平明显低于术后24h水平（P均=0．000），也明显低于对照组术后120h水平（P均〈0．05）。两组间及手术前后的CRP水平差异无统计学意义。结论吲哚美辛栓叮降低胃肠道肿瘤患者术后应激性高血糖及胰岛素抵抗。

Objective To investigate the effect of indomethacin on insulin resistance and metabolic re- sponse to surgical injury in patients with gastrointestinal tumor. Methods Fifty-eight cases with gastric cancer or colon cancer were divided into an indomethacin group （ n = 28 ） and a control group （ n = 30）. All the operations were performed under general anesthesia. Patients in both groups were given parenteral nutrition 24 hours after operation for 5 - 7 days. Tbe patients in the indomethacin group were treated with indomethacin suppository （100 mg/12 h）. Fasting blood glucose （ FBG）, fasting serum insulin （ FINS）, creatinine （Cr） , blood urine nitrogen （ BUN ） , triglyceride （TG）, free fatty acid （FFA） and C-reactive protein （CRP） of the two groups were detected on the day before operation, and 24, 72, 120 hours after operation. Insulin resistance index （HOMA-IR） was calculated by using the homeostasis model assessment （HOMA）. The vital signs were observed in 72 hours after operation. Re- sults The vital signs in the indomethacin group were more steady. The levels of FBG, FINS, and lnHOMA-IR of the control group 24 hours and 72 hours after operation were higher than before operation （ all P = 0. 000 ） and those of the indomethacin group （ all P 〈0.01 ）. In both of the two groups, the levels of Cr, BUN, TG, and FFA were higher than those before operation, but declined over time. All the indexes in the indomethacin group 120 hours after operation decreased significantly compared with the levels 24 hours after operation （ all P = 0. 000）, as well as with the levels in the control group 120 hours after operation （all P 〈 0. 05 ）. No significant difference was found in the level of CRP between the two groups and between before and after operation. Conclusion Indomethacin could reduce the postoperative stress hyperglycemia and insulin resistance in patients with gastrointestinal tumor.