放、化疗对恶性肿瘤患者血糖代谢的影响

Study on Radiotherapy-induced and Chemotherapy-induced Disorders of Glucose Metabolism in Patients with Malignant Tumor

目的观察放、化疗对恶性肿瘤患者血糖代谢的影响，并对其机制作初步探讨。方法所有恶性肿瘤患者均非胰腺癌或肝细胞癌，也无糖尿病史。其中79例患者共获得113次化疗前的空腹血糖、胰岛素、c肽值；30例患者获得了放射治疗前后空腹血糖、胰岛素和C肽水平的对照值；19例患者获得了第一次化疗前及末次化疗后空腹血糖、胰岛素和C肽水平的对照值，16例患者获得了单次化疗前后的对照值。并对所有患者化疗前的空腹血糖、胰岛素、C肽、胰岛素抵抗指数（HOMA—IR）及胰岛素分泌功能指数（HOMA．13）均与疗程作相关分析。结果经过整个疗程化疗后患者的血清胰岛素、C肽水平有升高（P〈0．05）；胰岛素、HOMA．IR值与既往化疗次数存在正相关关系（P〈0．01）。结论经过完整疗程化疗后恶性肿瘤患者血清胰岛素、c肽水平升高；长期化疗可导致胰岛素升高，并诱发胰岛素抵抗。

Objective To detect the levels of blood glucose,insulin and C-peptide in patients with malignant tumor before and after the radiotherapy and chemotherapy, study on radiotherapy-induced and chemotherapy- induced disorders of glucose metabolism in patients with malignant tumor, and make a preliminary study of the mechanism.Methods All of the patients with the malignant tumor were not pancreatic cancer or hepatocellular carcinoma,also do not have diabetes history.We received 113 control values of blood glucose,insulin and C-peptide in the 79 patients before the chemotherapy;30 control values of blood glucose,insulin and C-peptide in the patients of before and after radiotherapy; 19 control values of before the first chemotherapy and after the last chemotherapy, and 16 control values of before and after chemotherapy.All of the values of blood glucose,insulin,C- peptide,HOMA-IR and HOMA-13 in the patients before chemotherapy were analyzed with the course of treatment.Result The values of the insulin and C-peptide were increased after the whole cycles of chemotherapy（P 〈 0.05）;The values of the insulin and HOMA-IR were positive relevant with the times of chemotherapy within the past time.Conclusion The insulin,C-peptide levels are increased after the whole cycles of chemotherapy, and the insulin levels will be higher and it will be insulin resistant with the more cycles of chemotherapy.