曲马多对妊娠期糖尿病产妇剖宫产术后胰岛素抵抗的影响  

Effects of Tramadol on Insulin Resistance during Cesarean Section Complicated with Gestational Diabetes Mellitus

作　　者：林远贵[1,2] 黄蔚[1,2] 

机构地区：[1]四川大学华西第二医院麻醉科,成都610041 [2]四川大学华西第二医院出生缺陷与相关妇儿疾病教育部重点实验室,成都610041

出　　处：《四川大学学报（医学版）》2017年第3期446-449,459,共5页Journal of Sichuan University(Medical Sciences)

摘　　要：目的探讨曲马多对妊娠期糖尿病(GDM)产妇剖宫产术后胰岛素抵抗的影响。方法纳入2015年12月至2016年10月在我院行择期剖宫产,且GDM为A1级的产妇120例,随机分为4组,分别为曲马多预处理组TRM1(0.5mg/kg)、TRM2(1mg/kg)、TRM3(1.5mg/kg)和生理盐水对照组(CON组),每组30例。产妇于腰硬联合麻醉下行子宫下段横切口剖宫产术,其中TRM组产妇于胎儿与母体脐带分离即刻分别按质量浓度分组静注盐酸曲马多注射液,CON组则注射同体积生理盐水。于麻醉前(T0)、母婴脐带分离即刻(T1)和术毕即刻(T2)采集外周静脉血,观察各组产妇胰岛素抵抗水平的变化,应用ELISA检测血清中白介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)的表达;于关腹前采集各组产妇的大网膜组织,应用RT-PCR和Western blot检测PI3K/Akt信号通路的活动水平。结果与T_0相比,T_1与T_2时刻各组产妇血糖、胰岛素、胰岛素抵抗指数及炎性因子IL-6和TNF-α的表达均升高,差异有统计学意义(P<0.05)。但经曲马多预处理后,于T_2时刻,TRM2和TRM3组的胰岛素抵抗水平及炎性因子水平均较CON组有所改善(P<0.05),但TRM1组的上述指标较CON组改善不明显(P>0.05)。与CON组相比,TRM2和TRM3组大网膜组织中PI3 K和Akt的基因及蛋白表达水平升高,差异有统计学意义(P<0.05)。结论曲马多能降低GDM产妇剖宫产术后胰岛素抵抗水平,其机制可能与降低IL-6和TNF-α的表达及活化PI3K/Akt信号通路干预胰岛素抵抗有关。Objective To investigate the effects of tramadol on insulin resistance （IR） during cesarean section complicated with gestational diabetes mellitus （ GDM ）. Methods 120 patients of elective caesarean sectioncomplicated with G-DM （level A1） were collected from Dec. 2015 to Oct. 2016, randomly divided into the tramadol injection treated groups （0. 5 mg/kg TRM1, 1 mg/kg-TRM2 and 1. 5 mg/kg-TRM3） and the control group （CON） （n--30）. The patients of TRM groups were injected with tramadol after delivery of fetus during caesarean delivery under combined spinal-epidural anaesthesia （CSEA） and the patients of CON group were treated with normal saline as control. The plasma were collected before CSEA （To）, after delivery of fetus （T1） and immediately after caesarean section （T2） for determination of the expression of blood glucose, insulin, HOMA-IR, interleukin-6 （IL 6） and tumor necrosis factor-a （TNF-a） by hexokinase, chemiluminescence method and ELISA. The activation of PI3K/Akt signaling pathway of epiploon were detected by RT PCR and Western blot. Results Compared with To, the concentration of blood glucose, insulin, HOMA-IR, IL 6 and TNF-a increased significantly in T1 and T2 （P〈0.05）. The factors of above decreased in T2 of TRM2 group and TRM3 group comparing with CON group, but of no significant differences between TRM1 group and CON group. Compared with CON group in T2, PI3K/Akt signaling pathway activated significantly in TRM2 group and TRM3 group （P〈0.05）. Conclusion The tramadol can attenuate IR during cesarean section complicated with GDM and may regulate the secretion of IL- 6, TNF-a and PI3K/Akt signaling pathway in the treatment of IR of GDM.

关 键 词：妊娠期糖尿病 胰岛素抵抗 曲马多 PI3K 肿瘤坏死因子-Α 

分 类 号：R614[医药卫生—麻醉学]