• 西安交通大學(xué)第一附屬醫(yī)院普通外科(西安 710061);

目的 研究影響普通外科擇期手術(shù)后胰島素抵抗的相關(guān)因素。
方法 選擇2009年3～10月期間入住我院普通外科患者263例，分別記錄患者的臨床常用參數(shù): 年齡、性別、吸煙史、飲酒史、高血壓病史、手術(shù)史，人體測量指標(biāo)，如身高、體重、腰圍，與手術(shù)相關(guān)的手術(shù)時間、手術(shù)方式、術(shù)中輸血量和術(shù)中輸液量，檢測術(shù)前(手術(shù)前1 d)、術(shù)后(術(shù)后第1天)空腹血糖(BG)和血胰島素(INS)指標(biāo)，并利用穩(wěn)態(tài)模式評估法(HOMA)推算胰島素抵抗指數(shù)(HOMA-IR)和胰島素分泌指數(shù)(HOMA-β)。因HOMA-IR不呈正態(tài)分布，取對數(shù)化的HOMA-IR，即lnHOMA-IR。
結(jié)果 術(shù)后BG、INS和lnHOMAIR水平均明顯高于術(shù)前(P lt;0.001)，胰島素抵抗與患者性別(P=0.002)、吸煙史(P=0.033)、腰圍(P=0.000)、手術(shù)方式(P=0.007)以及術(shù)中輸液量(P=0.001)有關(guān)。開腹手術(shù)較非開腹手術(shù)胰島素抵抗程度嚴(yán)重(P lt;0.001)。
結(jié)論 普通外科擇期手術(shù)存在胰島素抵抗，減少手術(shù)損傷對于減輕術(shù)后胰島素抵抗有重要意義。

引用本文： 張迪,車向明,李海軍,甘建新,張丹杰,廖新華. 普通外科擇期手術(shù)后胰島素抵抗的臨床研究. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(9): 951-954. doi: 復(fù)制

1. Lee S, Muniyappa R, Yan X, et al. Comparison between surrogate indexes of insulin sensitivity and resistance and hyperinsulinemic euglycemic clamp estimates in mice [J]. Am J Physiol Endocrinol Metab, 2008; 294(2): E261E270.
2. Thorell A, Nygren J, Hirshman MF, et al. Surgeryinduced insulin resistance in human patients: relation to glucose transport and utilization [J]. Am J Physiol, 1999; 276(4 Pt 1): E754E761.
3. Thorell A, Nygren J, Essén P, et al. The metabolic response to cholecystectomy: insulin resistance after open compared with laparoscopic operation [J]. Eur J Surg, 1996; 162(3): 187191.
4. Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome [J]. Lancet, 2005; 365(9468): 14151428.
5. Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and betacell function from fasting plasma glucose and insulin concentrations in man [J]. Diabetologia, 1985; 28(7): 412419.
6. Lewis KS, KaneGill SL, Bobek MB, et al. Intensive insulin therapy for critically ill patients [J]. Ann Pharmacother, 2004; 38(78): 12431251.
7. Mather KJ, Hunt AE, Steinberg HO, et al. Repeatability characteristics of simple indices of insulin resistance: implications for research applications [J]. J Clin Endocrinol Metab, 2001; 86(11): 54575464.
8. Orford NR. Intensive insulin therapy in septic shock [J]. Crit Care Resusc, 2006; 8(3): 230234.
9. DeFronzo RA, Tobin JD, Andres R. Glucose clamp technique: a method for quantifying insulin secretion and resistance [J]. Am J Physiol, 1979; 237(3): E214E223.
10. Malita FM, Karelis AD, StPierre DH, et al. Surrogate indexes vs. euglycaemichyperinsulinemic clamp as an indicator of insulin resistance and cardiovascular risk factors in overweight and obese postmenopausal women [J]. Diabetes Metab, 2006; 32(3): 251255.
11. 燕曉雯, 李維勤, 虞文魁, 等. 外科感染患者胰島素抵抗及其相關(guān)因素分析 [J]. 外科理論與實踐， 2006; 11(1): 1419.
12. Greisen J, Juhl CB, Grfte T, et al. Acute pain induces insulin resistance in humans [J]. Anesthesiology, 2001; 95(3): 578584.
13. Moller DE, Flier JS. Insulin resistance-mechanisms, syndromes, and implications [J]. N Engl J Med, 1991; 325(13): 938948.
14. Anai M, Funaki M, Ogihara T, et al. Altered expression levels and impaired steps in the pathway to phosphatidylinositol 3kinase activation via insulin receptor substrates 1 and 2 in Zucker fatty rats [J]. Diabetes, 1998; 47(1): 1323.
15. Arner P. Insulin resistance in type 2 diabetes-role of the adipokines [J]. Curr Mol Med, 2005; 5(3): 333339.
16. GuerreMillo M, Rouault C, Poulain P, et al. PPARαnull mice are protected from highfat dietinduced insulin resistance [J]. Diabetes, 2001; 50(12): 28092814.
17. Uranga AP, Levine J, Jensen M. Isotope tracer measures of meal fatty acid metabolism: reproducibility and effects of the menstrual cycle [J]. Am J Physiol Endocrinol Metab, 2005; 288(3): E547E555.
18. Votruba SB, Jensen MD. Sexspecific differences in leg fat uptake are revealed with a highfat meal [J]. Am J Physiol Endocrinol Metab, 2006; 291(5): E1115E1123.
19. Kuhl J, Hilding A, Ostenson CG, et al. Characterisation of subjects with early abnormalities of glucose tolerance in the Stockholm Diabetes Prevention Programme: the impact of sex and type 2 diabetes heredity [J]. Diabetologia, 2005; 48(1): 3540.
20. Laughlin GA, BarrettConnor E, May S. Sexspecific association of the androgen to oestrogen ratio with adipocytokine levels in older adults: the Rancho Bernardo Study [J]. Clin Endocrinol (Oxf), 2006; 65(4): 506513.
21. Lee CC, KasaVubu JZ, Supiano MA. Androgenicity and obesity are independently associated with insulin sensitivity in postmenopausal women [J]. Metabolism, 2004; 53(4): 507512.
22. Livingstone C, Collison M. Sex steroids and insulin resistance [J]. Clin Sci (Lond), 2002; 102(2): 151166.
23. 王治國, 楊喆, 秦環(huán)龍, 等. 術(shù)前口服碳水化合物改善術(shù)后胰島素抵抗的作用及其機理研究 [J]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(11): 799804.
  1. 1. Lee S, Muniyappa R, Yan X, et al. Comparison between surrogate indexes of insulin sensitivity and resistance and hyperinsulinemic euglycemic clamp estimates in mice [J]. Am J Physiol Endocrinol Metab, 2008; 294(2): E261E270.
  2. 2. Thorell A, Nygren J, Hirshman MF, et al. Surgeryinduced insulin resistance in human patients: relation to glucose transport and utilization [J]. Am J Physiol, 1999; 276(4 Pt 1): E754E761.
  3. 3. Thorell A, Nygren J, Essén P, et al. The metabolic response to cholecystectomy: insulin resistance after open compared with laparoscopic operation [J]. Eur J Surg, 1996; 162(3): 187191.
  4. 4. Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome [J]. Lancet, 2005; 365(9468): 14151428.
  5. 5. Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and betacell function from fasting plasma glucose and insulin concentrations in man [J]. Diabetologia, 1985; 28(7): 412419.
  6. 6. Lewis KS, KaneGill SL, Bobek MB, et al. Intensive insulin therapy for critically ill patients [J]. Ann Pharmacother, 2004; 38(78): 12431251.
  7. 7. Mather KJ, Hunt AE, Steinberg HO, et al. Repeatability characteristics of simple indices of insulin resistance: implications for research applications [J]. J Clin Endocrinol Metab, 2001; 86(11): 54575464.
  8. 8. Orford NR. Intensive insulin therapy in septic shock [J]. Crit Care Resusc, 2006; 8(3): 230234.
  9. 9. DeFronzo RA, Tobin JD, Andres R. Glucose clamp technique: a method for quantifying insulin secretion and resistance [J]. Am J Physiol, 1979; 237(3): E214E223.
  10. 10. Malita FM, Karelis AD, StPierre DH, et al. Surrogate indexes vs. euglycaemichyperinsulinemic clamp as an indicator of insulin resistance and cardiovascular risk factors in overweight and obese postmenopausal women [J]. Diabetes Metab, 2006; 32(3): 251255.
  11. 11. 燕曉雯, 李維勤, 虞文魁, 等. 外科感染患者胰島素抵抗及其相關(guān)因素分析 [J]. 外科理論與實踐， 2006; 11(1): 1419.
  12. 12. Greisen J, Juhl CB, Grfte T, et al. Acute pain induces insulin resistance in humans [J]. Anesthesiology, 2001; 95(3): 578584.
  13. 13. Moller DE, Flier JS. Insulin resistance-mechanisms, syndromes, and implications [J]. N Engl J Med, 1991; 325(13): 938948.
  14. 14. Anai M, Funaki M, Ogihara T, et al. Altered expression levels and impaired steps in the pathway to phosphatidylinositol 3kinase activation via insulin receptor substrates 1 and 2 in Zucker fatty rats [J]. Diabetes, 1998; 47(1): 1323.
  15. 15. Arner P. Insulin resistance in type 2 diabetes-role of the adipokines [J]. Curr Mol Med, 2005; 5(3): 333339.
  16. 16. GuerreMillo M, Rouault C, Poulain P, et al. PPARαnull mice are protected from highfat dietinduced insulin resistance [J]. Diabetes, 2001; 50(12): 28092814.
  17. 17. Uranga AP, Levine J, Jensen M. Isotope tracer measures of meal fatty acid metabolism: reproducibility and effects of the menstrual cycle [J]. Am J Physiol Endocrinol Metab, 2005; 288(3): E547E555.
  18. 18. Votruba SB, Jensen MD. Sexspecific differences in leg fat uptake are revealed with a highfat meal [J]. Am J Physiol Endocrinol Metab, 2006; 291(5): E1115E1123.
  19. 19. Kuhl J, Hilding A, Ostenson CG, et al. Characterisation of subjects with early abnormalities of glucose tolerance in the Stockholm Diabetes Prevention Programme: the impact of sex and type 2 diabetes heredity [J]. Diabetologia, 2005; 48(1): 3540.
  20. 20. Laughlin GA, BarrettConnor E, May S. Sexspecific association of the androgen to oestrogen ratio with adipocytokine levels in older adults: the Rancho Bernardo Study [J]. Clin Endocrinol (Oxf), 2006; 65(4): 506513.
  21. 21. Lee CC, KasaVubu JZ, Supiano MA. Androgenicity and obesity are independently associated with insulin sensitivity in postmenopausal women [J]. Metabolism, 2004; 53(4): 507512.
  22. 22. Livingstone C, Collison M. Sex steroids and insulin resistance [J]. Clin Sci (Lond), 2002; 102(2): 151166.
  23. 23. 王治國, 楊喆, 秦環(huán)龍, 等. 術(shù)前口服碳水化合物改善術(shù)后胰島素抵抗的作用及其機理研究 [J]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(11): 799804.