【摘要】 目的研究胰岛素强化治疗对胃癌手术病人白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及C-反应蛋白(CRP)水平的影响,探讨其可能的抗炎机制。方法46例胃癌手术病人随机分为胰岛素强化治疗组(n=23,血糖控制在4.4~6.1 mmoL/L)和常规治疗组(n=23,血糖控制在10.0~11.1 mmoL/L),动态监测围手术期空腹血糖(FBG)、空腹胰岛素定量(FINS)、IL-6、TNF-α及CRP水平,并根据稳态模式评估法(HOMA)计算胰岛素抵抗指数(HOMA-IR),并对其与TNF-α、IL-6相关性进行分析。结果两组病人均无低糖血症发生,TNF-α、IL-6与HOMA-IR存在显著正相关(r=0.333~0.480,P<0.05);强化治疗组术后1、3 d血清lnHOMA-IR、IL-6、TNF-α明显低于常规治疗组(t=2.069~3.098,P<0.05),术后1、3、7 d的CRP明显低于常规治疗组(t=2.482~3.131,P<0.05)。结论TNF-α、IL-6与外科胰岛素抵抗相关,胰岛素强化治疗可以拮抗术后机体的高炎状态,抗炎效应可能是胰岛素强化治疗改善病人预后的重要机制之一。更多还原

【Abstract】 Objective To investigate the influence of intensive insulin therapy on serum levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6) and C-reactive protein(CRP),and to explore its underlying anti-inflammatory mechanism.MethodsForty-six patients were evenly divided into two groups in random: intensive group(blood glucose 4.4-6.1 mmoL/L) and conventional group(blood glucose 10.0-11.1 mmoL/L).Fasting blood glucose,fasting insulin,TNF-α,IL-6 and CRP in all patients were detected dynamically during perioperative period.Insulin resistance index(HOMA-IR) were calculated using Hemeostasis Model Assessment(HOMA).The correlations between insulin resistance and IL-6,TNF-α were analyzed.Results Hypoglycemia did not happen in patients of both groups.HOMA-IR was positively correlated with TNF-α and IL-6(r=0.333-0.480,P<0.05).On the first and third day,after surgery,HOMA-IR and serum levels of IL-6 and TNF-α(t=2.069-3.098,P<0.05),and on the first,third and seventh day after surgery,CRP in patients in intensive group were significantly lower than that in patients in conventional group(t=2.482-3.131,P<0.05).Conclusion The cytokines TNF-α and IL-6 are related to surgery-induced insulin resistance.The underlying anti-inflammatory actions of insulin might contribute to the improved outcomes of postoperative patients.更多还原