N（2）-L-丙氨酰-L-谷氨酰胺对结肠癌患者围术期胰岛素抵抗的影响  

Effect of N（2）-L-alanyi-L-glutamine on perioperative insulin resistance resection

作　　者：崔彦[1] 胡柳[1] 刘月江[1] 吴亚谋[1] 景亮[1] 

机构地区：[1]东南大学附属中大医院麻醉科,南京市210009

出　　处：《中华麻醉学杂志》2011年第7期785-788,共4页Chinese Journal of Anesthesiology

基　　金：江苏省自然科学基金（BK2008303）

摘　　要：目的评价N（2）-L-丙氨酰-L谷氨酰胺对结肠癌患者围术期胰岛素抵抗的影响。方法择期行结肠癌根治术的非糖尿病患者60例，年龄35—75岁，BMI18．5—25．0kg／m^2，ASA分级Ⅰ或Ⅱ级，采用随机数字表法，将其随机分为3组（n=20）：对照组（C组）于术前24h、术后1h静脉输注生理盐水22．5ml／kg；载体溶液组（V组）于术前24h、术后1h静脉输注复方氨基酸22．5ml／kg；药物治疗组（Ala-Gln组）于术前24h、术后1h静脉输注N（2）-L-丙氨酰-L谷氨酰胺（含谷氨酰胺0．5g／kg，溶于复方氨基酸）22．5ml／kg。于术前24h（L）、麻醉前30min（T2）、麻醉给药后3h（T3）、术后1h（T4）和24h（T5）时空腹条件下采集静脉血样，测定血糖（BG）、血清胰岛素（INS）、TNF-α、游离脂肪酸（FFA）的浓度，计算胰岛素抵抗指数（HOMA-IR）及胰岛素敏感指数（ISI）。记录术后的排气时间、住院时间及用药后胰岛素抵抗的发生情况。结果与C组和V组比较，Ala—Gin组血清INS、TNF-α、FFA的浓度、BG、HOMA-IR降低，ISI升高，胰岛素抵抗发生率降低，术后排气时间及住院时间明显缩短（P〈0．05）。C组和V组各指标比较差异无统计学意义（P〉0．05）。结论N（2）-L-丙氨酰-L-谷氨酰胺可有效地减轻结肠癌患者围术期胰岛索抵抗，有助于患者术后恢复，其作用机制可能与谷氨酰胺可降低血液TNF-α及FFA的浓度有关。Objective To evaluate the effect of N（2）-L-alanyl-L-glutamine （Ala-Glu） on perioperative insulin resistance in patients undergoing radical colon cancer operation. Methods Sixty ASA Ⅰ or Ⅱ patients of both sexes aged 35-75 yr with BMI of 18.5-25.0 kg/m^2 undergoing redical colon cancer operation under general anesthesia were randomly divided into 3 groups （ n = 20 each） ： control group（group C） ; vehicle group （group V） and group Ala-Glu. Ala-Glu 22.5 ml/kg was administered iv at 24 h before and 1 h after operation in group AlaGlu, while in groups C and V equal volume of normal saline and vehicle were given iv instead of Ala-Glu. Venous blood samples were taken at 24 h before operation （T1）, 30 min before （T2） and 3 h after induction of anesthesia （T3） and 1 and 24 h after operation （T4 , T5 ） for determination of blood concentrations of glucose （BG）, insulin （INS）, TNF-α and free fatty acid （FFA）. Insulin resistance （HOMA-IR = BG × INS ＋ 22.5） and insulin sensitivity index （ISI = 1 ＋ （lgBG ＋ lgINS）） were calculated. The time when the patients passed flatus, the days of hospi- tali-zation after operation, and the incidence of insulin resistance were recorded. Results Ala-Glu significantly de- creased blood concentrations of BG, INS,TNF-a, FFA and HOMA-IR and increased ISI in group Ala-Glu as com- pared with groups C and V. The patients passed flatus earlier after operation and postoperative hospital stay was shorter and the incidence of insulin resistance was lower in group Ala-Glu than in groups C and V. There was no significant difference in all the indexes between group C and group V. Conclusion N （2）-L-alanyl-L-glutamine can attenuate perioperative insulin resistance in patients undergoing colon cancer resection and is helpful to patient＇s recovery, and the decrease in the concentrations of TNF-α and FFA may be involved in the mechanism.

关 键 词：谷氨酰胺 胰岛素抗药性 结肠肿瘤 

分 类 号：R735.35[医药卫生—肿瘤]