糖预负荷对胃癌术后胰岛素抵抗的影响及其相关研究

Impact of preoperative oral liquid carbohydrate on postoperative insulin resistance in gastric cancer patients and its associated study

目的探讨胃癌手术患者术前口服液态碳水化合物对术后胰岛素抵抗（IR）的影响，并探讨IR指数（HOMA．IR）与血清肿瘤坏死因子-α（TNV-α）水平的关系。方法前瞻性纳入2013年1—9月间广州军区广州总医院普通外科收治的拟行胃癌根治术的35例患者，采用随机数字表法分为试验组（18例。术前2h口服10％葡萄糖溶液）和对照组（17例，术前常规禁食、禁饮），两组关腹前均切取约300mg的腹直肌与皮下脂肪组织。分别手术前3h和术后1d计算两组患者的HOMA．IR，采用双抗体夹心ELISA法分别于术前3h、术后1d和术后3d检测血清TNF．OL浓度，WesternB10t法检测组织TNF-α表达水平：并分析HOMA—IR与TNF-α的相关性。结果试验组术前3h和术后1d的HOMA—IR指数变化不明显（P=0．090），术后1d明显低于对照组（P=-0．000）。试验组术毕血清TNF-α浓度较术前3h显著增高，但术后1d即明显下降，术后3d降至术前3h水平；对照组术毕TNF-α浓度也较术前3h明显增高，术后1d升至高峰，至术后3d仍高于术前3h水平。试验组术毕肌肉组织中TNF-α表达量较对照组显著增高（P=0．001）；而脂肪组织中两组差异无统计学意义（P=0．987）。相关性分析显示，HOMA．IR在术后1d时与TNF-α呈显著性正相关（r：0．832，P=0.000）。结论术前2h口服液态碳水化合物可在一定程度上降低术后TNF-α水平，其在术后IR的改善中起重要作用。

Objective To investigate the impact of preoperative oral liquid carbohydrate on postoperative insulin resistance （IR） in gastric cancer patients undergoing elective resection, and to examine the association of IR index （homeostasis model assessment, HOMA-IR） with tumor necrosis factor--α （TNF--α）. Methods Between January 2013 and September 2013, 35 patients undergoing elective resection for gastric cancer were prospectively enrolled and randomized into two groups. Patients in trial group （n=18） received oral 500 ml of 10% glucose solution two hours before surgery. Patients in control group （n=17） were asked to fast for 8-12 hours before operation. About 300 mg of rectus abdominis and subcutaneous fatty tissues was removed before the closure of abdominal wall. Blood samples were collected to measure the serum concentration of TNF-αwith double antibody sandwich ELISA in perioperative period （3-hour before operation, end of operation, 1-day and 3-day after operation）. HOMA-IR was calculated on preoperative 3-hour and postoperative 1-day. Western blotting was used to detect protein expression of TNF-α Correlation of HOMA-IR with TNF-α was examined. Results HOMA-IR on the first day after surgery was not different from that at 3-hour before surgery in trial group （P=0.090）, which was significantly lower than that in control group （P=0.000）. In trial group, serum TNF-α at the end of operation was higher than that at 3-hour before surgery, which declined rapidly on the first day after surgery and had no significant difference compared with that on the third day after surgery. In control group, serum TNF-cx at the end of operation was also higher than that before surgery, which rose to the peak on the first day after surgery and was still higher than that at 3-hour before surgery. The TNF-α protein expression in muscle tissues of trial group was higher than that of control group （P=0.001）, while no significant difference was observed between two groups in adipose tissues （P=0.987）. Correlation analysis showed that HOMA-IR was positively correlated with TNF-α on the first day after surgery （r =0.832, P=0.000）. Conclusion Oral intake of liquid carbohydrate 2 hours before surgery can reduce the level of TNF-α, which is likely to improve the postoperative insulin resistance.