心脏瓣膜置换术围术期瘦素与胰岛素抵抗  

Leptin and insulin resistance in the perioperation of cardiac valve replacement

作　　者：杜海侠[1] 

机构地区：[1]南阳医学高等专科学校第一附属医院普胸外科Ⅱ,河南南阳473058

出　　处：《中国实用医刊》2013年第17期45-47,共3页Chinese Journal of Practical Medicine

摘　　要：目的探讨心脏瓣膜置换术围术期胰岛素抵抗发生与瘦素的关系。方法20例心脏瓣膜置换术患者分别于麻醉前及术后2、12、24、48h采集血样，测定瘦素、胰岛素、血糖和红细胞压积，计算稳态胰岛素抵抗指数（HOMA．IR）、胰岛素敏感性指数[1／（G×INS）]和胰岛素血糖比值（I／G）。结果胰岛素、血糖和HOMA—IR在麻醉开始后显著升高，与麻醉前相比差异有统计学意义（P〈0．05）；1／（G×INS）与麻醉前相比显著下降，差异有统计学意义（P〈0．05）；术后2h瘦素与麻醉前相比显著下降，差异有统计学意义（P〈0．05），术后24h时逐步上升达到峰值（P〈0．01）。瘦素与HOMA—IR呈显著的正相关（r=0．958，P=0．010）。结论在心脏瓣膜置换术围术期机体出现强烈的胰岛素抵抗，瘦素在心脏瓣膜置换术围术期IR的发生、发展中可能发挥重要的作用。Objective To investigate the relationship between insulin resistance and leptin in the perioperation of cardiac valve replacement. Methods Twenty patients were treated with cardiac valve replacement. Blood samples were obtained at the following intervals： before anesthesia, 2 h, 12 h, 24 h and 48 h after cardiac valve replacement. The concentrations of leptin, insulin, hematokrit and blood glucose were measured. The insulin-resistance index （ HOMA-IR）, insulin-sensitivity index [ 1/ （INS x G）] and the ratio of insulin to blood glucose（I/G） were obtained. Results Insulin, blood glucose and HOMA-IR increased significantly from the beginning of anesthesia and went to the peak at 24 h after cardiac valve replacement （ P 〈 0.05 ）. 1/（ INS x G） decreased significantly after an- esthesia （P 〈 0. 05 ）. Leptin level decreased gradually at the beginning and increased rapidly to the peak at 24 h after operation （P 〈 0. 01）. HOMA-IR correlated well with leptin （r = 0. 958, P = 0. 010）. Conclusions Insulin resistance exists in the perioperation of cardiac valve replacement. Correlation be- tween leptin and insulin-resistance index indicates the role of leptin in insulin-resistance.

关 键 词：心脏瓣膜置换术 胰岛素抵抗 瘦素 

分 类 号：R654.2[医药卫生—外科学]