術前口服碳水化合物改善術后胰島素抵抗的作用及其機理研究_《中國普外基礎與臨床雜志》

作者：

王治國 , 楊喆 , 秦環龍

上海交通大學附屬第六人民醫院普外科（上海 200233）;

關鍵詞：

大腸癌手術碳水化合物胰島素抵抗機理

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目的評價機體對口服碳水化合物的耐受性、觀察口服碳水化合物對術后胰島素抵抗的作用并探討其可能機理。方法選取擇期行結直腸癌根治術患者32例并隨機分為對照組和試驗組。對照組術前禁食，試驗組術前口服碳水化合物溶液。分別比較2組患者術前主觀舒適度、術前以及術后即刻HOMA指數，術后即刻2組間PTK活性，PI3K、PKB 和GluT4的mRNA和（或）蛋白表達水平。結果試驗組臨手術前口渴感、饑餓感和焦慮感較對照組明顯改善(P＜0.05)；與術前比較，術后試驗組胰島素敏感指數降低了33%，而對照組降低了38%（P=0.007 2）；術后試驗組PTK活性、PKB及PI3K的mRNA和蛋白表達水平均高于對照組(P＜0.05，P＜0.01),但2組的GluT4 mRNA表達水平比較差異無統計學意義(P gt;0.05)。結論術前口服碳水化合物安全有效，它可改善術后即刻的胰島素抵抗。這種富糖溶液可在麻醉或手術開始時就通過相對增強胰島素信號轉導通路上PTK、PI3K、PKB等激酶的活性來增強胰島素活性，這是術前口服碳水化合物改善術后胰島素抵抗的可能機理之一。

引用本文： 王治國,楊喆,秦環龍. 術前口服碳水化合物改善術后胰島素抵抗的作用及其機理研究. 中國普外基礎與臨床雜志, 2008, 15(11): 799-804. doi: 復制

1.	Thorell A, Efendic S, Gutniak M, et al. Insulin resistance after abdominal surgery [Ｊ]. Br J Surg, 1994; 81(1)∶59.
2.	Van den Berghe G, Wouters PJ, Bouillon R, et al. Outcome benefit of intensive insulin therapy in the critically ill: Insulin dose versus glycemic control [Ｊ]. Crit Care Med, 2003; 31(2)∶359.
3.	Nygren J, Thorell A, Jacobsson H, et al. Preoperative gastric emptying. Effects of anxiety and oral carbohydrate administration [Ｊ]. Ann Surg, 1995; 222(6)∶728.
4.	Brezinski D, Stone PH, Muller JE, et al. Prognostic significance of the Karnofsky Performance Status score in patients with acute myocardial infarction: comparison with the left ventricular ejection fraction and the exercise treadmill test performance. The MILIS Study Group [Ｊ]. Am Heart J, 1991; 121(5)∶1374.
5.	Haffner SM, Kennedy E, Gonzalez C, et al. A prospective analysis of the HOMA model. The Mexico City Diabetes Study [Ｊ]. Diabetes Care, 1996; 19(10)∶1138.
6.	Maltby JR, Lewis P, Martin A, et al. Gastric fluid volume and pH in elective patients following unrestricted oral fluid until three hours before surgery [Ｊ]. Can J Anaesth, 1991; 38(4 Pt 1)∶425.
7.	Thorell A, Nygren J, Ljungqvist O. Insulin resistance: a marker of surgical stress [Ｊ]. Curr Opin Clin Nutr Metab Care, 1999; 2(1)∶69.
8.	Krinsley JS. Effect of an intensive glucose management protocol on the mortality of critically ill adult patients [Ｊ]. Mayo Clin Proc, 2004; 79(8)∶992.
9.	Nygren J, Soop M, Thorell A, et al. Preoperative oral carbohydrates and postoperative insulin resistance [Ｊ]. Clin Nutr, 1999; 18(2)∶117.
10.	Nygren J, Thorell A, Ljungqvist O. Preoperative oral carbohydrate nutrition: an update [Ｊ]. Curr Opin Clin Nutr Metab Care, 2001; 4(4)∶255.
11.	Soop M, Nygren J, Myrenfors P， et al. Preoperative oral carbohydrate treatment attenuates immediate postoperative insulin resistance [Ｊ]. Am J Physiol Endocrinol Metab, 2001; 280(4)∶E576.
12.	Nygren JO, Thorell A, Soop M, et al. Perioperative insulin and glucose infusion maintains normal insulin sensitivity after surgery [Ｊ]. Am J Physiol, 1998; 275(1 Pt 1)∶E140.
13.	Nygren J, Soop M, Thorell A, et al. Preoperative oral carbohydrate administration reduces postoperative insulin resistance [Ｊ]. Clin Nutr, 1998; 17(2)∶65.
14.	Ljungqvist O, Thorell A, Gutniak M, et al. Glucose infusion instead of preoperative fasting reduces postoperative insulin resistance [Ｊ]. J Am Coll Surg, 1994; 178(4)∶329.
15.	Thorell A Eds. Insulin resistance after elective surgery and the eff-ect of preoperative glucose infusion [M]. Stockholm, Sweden: Karolinska Hospital and Institute, 1993.
16.	Crowe PJ, Dennison A, Royle GT. The effect of pre-operative glucose loading on postoperative nitrogen metabolism [Ｊ]. Br J Surg, 1984; 71(8)∶635.
17.	Svanfeldt M, Thorell A, Hausel J, et al. Effect of “preoperative” oral carbohydrate treatment on insulin action-a randomised cross-over unblinded study in healthy subjects [Ｊ]. Clin Nutr, 2005; 24(5)∶815.
18.	Hausel J, Nygren J, Lagerkranser M, et al. A carbohydrate-rich drink reduces preoperative discomfort in elective surgery patients [Ｊ]. Anesth Analg, 2001; 93(5)∶1344.
19.	Cheatham B, Kahn CR. Insulin action and the insulin signaling network [Ｊ]. Endocr Rev, 1995; 16(2)∶117.
20.	Shepherd PR, Withers DJ, Siddle K. Phosphoinositide 3-kinase: the key switch mechanism in insulin signalling [Ｊ]. Biochem J, 1998; 333 (Pt 3)∶471.
21.	Han DH, Hansen PA, Host HH, et al. Insulin resistance of muscle glucose transport in rats fed a high-fat diet: a reevaluation [Ｊ]. Diabetes, 1997; 46(11)∶1761.
22.	Zierath JR, He L, Gumà A, et al. Insulin action on glucose transport and plasma membrane GluT4 content in skeletal muscle from patients with NIDDM [Ｊ]. Diabetologia, 1996; 39(10)∶1180.
23.	Zorzano A, Fandos C, Palacín M. Role of plasma membrane transporters in muscle metabolism [Ｊ]. Biochem J, 2000; 349 Pt 3∶667.

1. Thorell A, Efendic S, Gutniak M, et al. Insulin resistance after abdominal surgery [Ｊ]. Br J Surg, 1994; 81(1)∶59.
2. Van den Berghe G, Wouters PJ, Bouillon R, et al. Outcome benefit of intensive insulin therapy in the critically ill: Insulin dose versus glycemic control [Ｊ]. Crit Care Med, 2003; 31(2)∶359.
3. Nygren J, Thorell A, Jacobsson H, et al. Preoperative gastric emptying. Effects of anxiety and oral carbohydrate administration [Ｊ]. Ann Surg, 1995; 222(6)∶728.
4. Brezinski D, Stone PH, Muller JE, et al. Prognostic significance of the Karnofsky Performance Status score in patients with acute myocardial infarction: comparison with the left ventricular ejection fraction and the exercise treadmill test performance. The MILIS Study Group [Ｊ]. Am Heart J, 1991; 121(5)∶1374.
5. Haffner SM, Kennedy E, Gonzalez C, et al. A prospective analysis of the HOMA model. The Mexico City Diabetes Study [Ｊ]. Diabetes Care, 1996; 19(10)∶1138.
6. Maltby JR, Lewis P, Martin A, et al. Gastric fluid volume and pH in elective patients following unrestricted oral fluid until three hours before surgery [Ｊ]. Can J Anaesth, 1991; 38(4 Pt 1)∶425.
7. Thorell A, Nygren J, Ljungqvist O. Insulin resistance: a marker of surgical stress [Ｊ]. Curr Opin Clin Nutr Metab Care, 1999; 2(1)∶69.
8. Krinsley JS. Effect of an intensive glucose management protocol on the mortality of critically ill adult patients [Ｊ]. Mayo Clin Proc, 2004; 79(8)∶992.
9. Nygren J, Soop M, Thorell A, et al. Preoperative oral carbohydrates and postoperative insulin resistance [Ｊ]. Clin Nutr, 1999; 18(2)∶117.
10. Nygren J, Thorell A, Ljungqvist O. Preoperative oral carbohydrate nutrition: an update [Ｊ]. Curr Opin Clin Nutr Metab Care, 2001; 4(4)∶255.
11. Soop M, Nygren J, Myrenfors P， et al. Preoperative oral carbohydrate treatment attenuates immediate postoperative insulin resistance [Ｊ]. Am J Physiol Endocrinol Metab, 2001; 280(4)∶E576.
12. Nygren JO, Thorell A, Soop M, et al. Perioperative insulin and glucose infusion maintains normal insulin sensitivity after surgery [Ｊ]. Am J Physiol, 1998; 275(1 Pt 1)∶E140.
13. Nygren J, Soop M, Thorell A, et al. Preoperative oral carbohydrate administration reduces postoperative insulin resistance [Ｊ]. Clin Nutr, 1998; 17(2)∶65.
14. Ljungqvist O, Thorell A, Gutniak M, et al. Glucose infusion instead of preoperative fasting reduces postoperative insulin resistance [Ｊ]. J Am Coll Surg, 1994; 178(4)∶329.
15. Thorell A Eds. Insulin resistance after elective surgery and the eff-ect of preoperative glucose infusion [M]. Stockholm, Sweden: Karolinska Hospital and Institute, 1993.
16. Crowe PJ, Dennison A, Royle GT. The effect of pre-operative glucose loading on postoperative nitrogen metabolism [Ｊ]. Br J Surg, 1984; 71(8)∶635.
17. Svanfeldt M, Thorell A, Hausel J, et al. Effect of “preoperative” oral carbohydrate treatment on insulin action-a randomised cross-over unblinded study in healthy subjects [Ｊ]. Clin Nutr, 2005; 24(5)∶815.
18. Hausel J, Nygren J, Lagerkranser M, et al. A carbohydrate-rich drink reduces preoperative discomfort in elective surgery patients [Ｊ]. Anesth Analg, 2001; 93(5)∶1344.
19. Cheatham B, Kahn CR. Insulin action and the insulin signaling network [Ｊ]. Endocr Rev, 1995; 16(2)∶117.
20. Shepherd PR, Withers DJ, Siddle K. Phosphoinositide 3-kinase: the key switch mechanism in insulin signalling [Ｊ]. Biochem J, 1998; 333 (Pt 3)∶471.
21. Han DH, Hansen PA, Host HH, et al. Insulin resistance of muscle glucose transport in rats fed a high-fat diet: a reevaluation [Ｊ]. Diabetes, 1997; 46(11)∶1761.
22. Zierath JR, He L, Gumà A, et al. Insulin action on glucose transport and plasma membrane GluT4 content in skeletal muscle from patients with NIDDM [Ｊ]. Diabetologia, 1996; 39(10)∶1180.
23. Zorzano A, Fandos C, Palacín M. Role of plasma membrane transporters in muscle metabolism [Ｊ]. Biochem J, 2000; 349 Pt 3∶667.

《中國普外基礎與臨床雜志》

術前口服碳水化合物改善術后胰島素抵抗的作用及其機理研究

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《中國普外基礎與臨床雜志》

術前口服碳水化合物改善術后胰島素抵抗的作用及其機理研究

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料