术前口服碳水化合物改善术后胰岛素抵抗的作用及其机理研究  

Study of Mechanism of Preoperative Oral Carbohydrate Involved in Attenuating Postoperative Insulin Resistance

作　　者：王治国[1] 杨喆[1] 秦环龙[1] 

机构地区：[1]上海交通大学附属第六人民医院普外科,上海200233

出　　处：《中国普外基础与临床杂志》2008年第11期799-804,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：上海市卫生科技发展基金重点项目(编号:200401)~~

摘　　要：目的评价机体对口服碳水化合物的耐受性、观察口服碳水化合物对术后胰岛素抵抗的作用并探讨其可能机理。方法选取择期行结直肠癌根治术患者32例并随机分为对照组和试验组。对照组术前禁食,试验组术前口服碳水化合物溶液。分别比较2组患者术前主观舒适度、术前以及术后即刻HOMA指数,术后即刻2组间PTK活性,PI3K、PKB和GluT4的mRNA和(或)蛋白表达水平。结果试验组临手术前口渴感、饥饿感和焦虑感较对照组明显改善(P<0.05);与术前比较,术后试验组胰岛素敏感指数降低了33%,而对照组降低了38%(P=0.0072);术后试验组PTK活性、PKB及PI3K的mRNA和蛋白表达水平均高于对照组(P<0.05,P<0.01),但2组的GluT4mRNA表达水平比较差异无统计学意义(P>0.05)。结论术前口服碳水化合物安全有效,它可改善术后即刻的胰岛素抵抗。这种富糖溶液可在麻醉或手术开始时就通过相对增强胰岛素信号转导通路上PTK、PI3K、PKB等激酶的活性来增强胰岛素活性,这是术前口服碳水化合物改善术后胰岛素抵抗的可能机理之一。Objective To assess the tolerance of preoperative carbohydrate-rich beverage, to determine its effect on postoperative insulin resistance and analyze its potential mechanism. Methods Thirty-two patients under going elective colorectal cancer resection were recruited to this randomized controlled study and assigned to two groups at random. Patient in control group was fasted before operation, while patient in study group was given oral water. Homeostasis model assessment （HOMA） indexes, activity of PTK, and mRNA and （or） protein expres sions of PKB, PI3K and GluT4 were measured before and （or） immediately after surgery. Furthermore preoperative well-beings of patients were studied. Results Among well-beings, feeling of thirst, hunger and anxiety tended to be better in patients receiving carbohydrate-rich beverages compared with fasted ones （P〈0.05）. Whole body insulin sensitivity decreased by 33% in the study group while 38% in the control group （P：0. 007 2）, and the activity of PTK, expressions of PI3K and PKB in study group were higher than those in control group （P〈0.05, P〈0.01）, but no significantly difference was observed about GluT4 in both groups （P〉0.05）. Conclusion Preoperative con sumption of carbohydrate containing fluids is safe and effective. Provision of carbohydrate energy source prior to surgery may attenuate immediate postoperative insulin resistance. A carbohydrate-rich drink enhances insulin action at the time of onset of anaesthesia or surgery by activating three kinases named PTK, PI3K, PKB which are key en zymes in pathway of insulin signal transduction. It is likely to explain the effects on postoperative insulin resistance.

关 键 词：大肠癌手术 碳水化合物 胰岛素抵抗 机理 

分 类 号：R619[医药卫生—外科学]