强化胰岛素治疗对胆源性脓毒症炎症反应水平的影响

目的探讨强化胰岛素治疗对胆源性脓毒症TNF-α、IL-6、C反应蛋白（CRP）及APACHEⅡ评分的影响,探讨其可能的抗炎机理。方法2005年1月至2008年12月4年期间我院普外科收治并于24h内实施手术的28例胆源性脓毒症患者,采用随机数字表编号法随机分为强化胰岛素治疗组（强化组,n=14）和常规胰岛素治疗组（对照组,n=14）,于术前及术后1、3、5和7d检测2组患者TNF-α、IL-6及CRP水平并计算APACHEⅡ评分。结果强化组术后5和7d的CRP水平及APACHEⅡ评分,术后3、5及7d的TNF-α和IL-6水平均明显低于对照组（P〈0.05,P〈0.01）。与术前比较,强化组IL-6及APACHEⅡ评分于术后3d开始明显下降（P〈0.05）,早于对照组。结论强化胰岛素治疗可抑制胆源性脓毒症术后TNF-α、IL-6及CRP的合成,保护受损的肝细胞,降低APACHEⅡ分值和全身炎症反应程度,从而减少MODS的发生。     

颅内幕上肿瘤术中血糖波动水平与术后血清炎性因子对患者短期预后的影响

目的探讨颅内幕上肿瘤术中血糖波动水平与术后肿瘤坏死因子-α(TNF-α)、IL-6和C反应蛋白(CRP)浓度对患者短期预后的影响。方法选择无糖尿病颅内幕上肿瘤切除术患者146例。根据术中血糖波动水平分为:血糖波动水平2.2mmol/L组(L组,n=97),血糖波动水平≥2.2mmol/L组(H组,n=49)。于术前1d空腹血糖(T0)、麻醉诱导后5min(T1)、术中最高血糖(峰血糖,T2)、术中最低血糖(谷血糖,T3)、关颅后5min(T4)、返回ICU即刻(T5)、ICU 2h(T6)采集右侧颈内静脉血2ml检测血糖。分别在术前1d和术后1、3、6d检测患者血清TNF-α、IL-6和CRP浓度;观察并记录术后房颤发生率、心肌缺血率,高血糖和低血糖发生率、呼吸支持时间、死亡情况。结果T2、T4~T6时H组血糖明显高于T0时和L组(P0.05或P0.01)。与术前1d比较,术后1、3和6d两组患者血清TNF-α、IL-6和CRP浓度明显升高(P0.01)。与L组比较,术后1、3和6d H组患者血清TNF-α、IL-6和CRP浓度明显升高(P0.05)。与L组比较,术后H组房颤、心肌缺血、高血糖、低血糖发生率明显增加,呼吸支持时间明显延长(P0.05)。结论在小批量患者的颅内幕上肿瘤手术患者中,术中血糖波动水平与术后血清炎性因子TNF-α、IL-6和CRP浓度有相关性,当血糖波动水平2.2mmol/L时患者预后较好。     

强化胰岛素治疗对严重多发伤患者炎症因子水平及预后的影响

目的观察强化胰岛素治疗对严重多发伤患者炎症因子及预后的影响。方法将53例严重多发伤患者随机分为治疗组(27例)和对照组(26例)。治疗组患者在基础治疗的基础上,加用胰岛素微量泵强化治疗,对照组血糖控制在11.1 mmol/L以下,分别在治疗前、后测定患者的肿瘤坏死因子(TNF-α)、白细胞介素(IL-1β)、IL-6、C反应蛋白(CRP)水平,并观察多器官功能障碍综合征、院内感染发生率和病死率。结果治疗组患者的TNF-α、IL-1β、IL-6、CRP水平显著低于对照组,差异有统计学意义(P0.05或P0.01),治疗组多器官功能障碍综合征、院内感染发生率及病死率低于观察组(P0.05)。结论强化胰岛素治疗可降低严重多发伤患者的炎症因子的表达水平,改善患者预后,降低院内感染的发生率及死亡率。     

胰岛素强化治疗对严重创伤患者炎性反应及预后的影响

目的 了解胰岛素强化治疗对严重创伤患者炎性反应及预后的影响.方法 将80例严重创伤患者按随机配对原则分为治疗组(40例)和对照组(40例).治疗组患者入院后立即行胰岛素强化治疗,从胰岛素泵泵入胰岛素2～4 U/h,控制血糖值在6～8 mmol/L;对照组按临床常规治疗,不给予胰岛素.观察2组患者的发热、器官损伤情况,统计病死率.于开始治疗后1、3、5、7 d晨抽取2组患者静脉血,检测血浆TNF-α、IL-2、IL-10、C反应蛋白(CRP)水平.结果 治疗组患者9例发生高热,低于对照组(29例).治疗组和对照组各有31例和30例患者出现1个脏器功能不全.治疗组和对照组同一患者出现3个脏器功能不全的分别为10、19例,出现4个脏器功能不全的分别为7、12例.治疗组伤后3 d内死亡4例,3 d以后死亡1例,病死率为12.5%;对照组伤后3 d内死亡5例,3 d以后死亡4例,病死率为22.5%.治疗后3～7 d,治疗组患者TNF-α、CRP值均低于对照组(P<0.05或P<0.01),而IL-2、IL-10值则均高于对照组(P<0.05或P<0.01).治疗后7 d,治疗组TNF-α、CRP值最低,分别为(1.3±0.6)μg/L、(55±16)mg/L,且明显低于对照组的(3.0±0.8)μg/L、(89±20)mg/L(P<0.01).结论 严重创伤后行胰岛素强化治疗,可以减轻患者全身性炎性反应程度,改善创伤患者预后.     

川芎嗪注射液对早期糖尿病肾病患者IL-6、TNF-α和CRP的影响

目的:探讨川芎嗪注射液对早期糖尿病肾病(Diabetic nephropathy,DN)患者白细胞介素-6(Interleukin-6.IL-6)、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)和C反应蛋白(C- reactive protein,CRP)的影响.方法:将80例早期DN患者随机分为对照组(40例)和治疗组(40例),对照组为常规西药治疗,治疗组在此基础上加用川芎嗪注射液,连用15天.采用ELISA法检测两组患者治疗前后血清IL-6、TNF-α和CRP水平,同时观察空腹血糖、血脂、24h尿蛋白等指标的变化.结果:与治疗前比较,治疗组患者血清IL-6、TNF-α和CRP水平均下降(P＜0.01),而对照组无明显变化(P＞0.05).结论:川芎嗪注射液可能通过减低DN患者血清IL-6、TNF-α和CRP水平,抑制炎症反应,起到对DN的保护作用.     

脊柱术后患者体温、WBC、CRP、IL-6、TNF-α的动态监测及临床意义

目的探讨脊柱术后患者体温、WBC、CRP、IL-6、TNF-α的动态变化及对脊柱术后感染的预测价值。方法将240例脊柱手术患者按照是否发生术后感染分为感染组(36例)和非感染组(204例)。统计两组患者术后1、3、7、14 d的体温、WBC、CRP、IL-6、TNF-α水平。结果术后3、7、14 d感染组体温、WBC计数明显高于同期非感染组,差异有统计学意义(P0.001)。术后1 d两组体温、WBC计数均达峰值,非感染组术后3、7、14 d体温、WBC计数呈下降趋势,但感染组术后3、7、14 d体温、WBC计数一直处于较高水平,差异有统计学意义(P0.001);术后1 d两组CRP、IL-6、TNF-α水平开始上升,术后3 d两组CRP、IL-6、TNF-α水平达峰值,术后7、14 d两组CRP、IL-6、TNF-α水平呈下降趋势,但术后3、7、14 d感染组CRP、IL-6、TNF-α水平明显高于同期非感染组(P0.001)。结论脊柱术后3 d患者体温、WBC、CRP、IL-6、TNF-α水平升高较为常见,但3 d后患者体温、WBC、CRP、IL-6、TNF-α水平仍处于较高水平,则预示患者术后感染可能性大。     

短期胰岛素强化治疗对围手术期高血糖患者胰岛β细胞功能的影响

【摘要】 目的 探讨短期胰岛素强化治疗对围手术期高血糖患者β细胞功能的影响。方法回顾性分析2011年1月~2013年7月我院短期胰岛素强化治疗围手术期高血糖的患者临床资料,其中采用持续性皮下胰岛素输注治疗患者25例(CSII组),采用多次皮下胰岛素注射治疗患者20例(MSII组)。治疗2周后,比较两组的血糖控制(FBG、2hPG、GSP)、β细胞功能、胰岛素敏感性指标以及TNF-α、IL-1β、CRP、APN的变化情况。结果〓CSII组与MSII组的FBG、2hPG、GSP水平均较治疗前显著降低,差异具有统计学意义(P<0.05);治疗后CSII组的FBG、2hPG、GSP水平与MSII组比较,差异不显著(P>0.05)。CSII组与MSII组的GSP、Homa-IR水平均较治疗前显著降低,Homa-β较治疗前显著升高,且与MSII组比较改善更显著(P<0.05);同样CSII组TNF-α、IL-1β、CRP水平与MSII组比较也改善更显著(P<0.05)。结论〓持续性皮下胰岛素输注治疗可有效控制血糖,显著改善胰岛β功能及提高胰岛素敏感性,其机制可能与下调炎性因子有关。     

血液灌流串联血液透析治疗对终末期糖尿病肾病患者胰岛素抵抗与营养状态的影响

目的：探讨血液灌流串联血液透析治疗对终末期糖尿病肾病（ESDN）患者胰岛素抵抗、微炎症状态与营养不良的关系.方法：入选ESDN患者75例,其中单纯血液透析组（HD组）25例、血液透析联合血液滤过组（HD＋ HDF组）28例、血液透析串联血液灌流组（HD ＋HP组）22例,比较各组患者治疗前、后与胰岛素抵抗、C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、血红蛋白（Hb）、血清白蛋白（Alb）、空腹胰岛素（FINS）、空腹血糖（FBS）及体重指数（BMI）的相关性,应用Daugirdas公式计算透析充分性（KT/V）,分析血液灌流串联血液透析对ESDN患者胰岛素抵抗、微炎症状态与营养不良的影响;健康人16例作为对照组.结果：治疗前,3组胰岛素抵抗、微炎症状态与营养状态差异无统计学意义（P＞0.05）,而CRP、TNF-α及IL-6均高于正常对照组（P＜0.001）;治疗12周后,血液灌流治疗与胰岛素抵抗、CRP、TNF-α、IL-6、Hb、Alb及BMI均显著相关;胰岛素抵抗和营养状态：HD＋ HP组治疗前后有改善（P＜0.05）,较HD组和HD＋ HDF组差异有统计学意义（P＜0.05）;炎症因子：HD＋ HP组治疗前后、以及较其他两组显著降低（P＜0.01）,较正常对照组仍增高（P＜0.05）,HD＋ HDF组与HD组之间差异也有统计学意义（P＜0.05）,HD组治疗前后差异无统计学意义（P＞0.05）.结论：血液透析的ESDN患者体内长期存在的胰岛素抵抗、微炎症状态和营养不良,血液灌流可有效清除炎症介质,降低ESDN患者的胰岛素抵抗,改善营养状态.     

胃癌根治术保留迷走神经对术后急性炎症反应的影响研究

目的：通过胃癌患者术前与术后血清CRP、IL-1β、IL-6、TNF-α、α-AT的表达比较,探讨保留迷走神经对胃癌根治术术后急性炎症反应的影响。方法：应用酶联免疫吸附法（ELISA）检测74例胃癌患者术前和术后血清中的CRP、IL-1β、IL-6、TNF-α、α-AT蛋白含量。结果：胃癌根治术保留迷走神经组术后CRP、IL-6、TNF-α等种蛋白表达低于未保留迷走神经组（P〈0.05）,实验组术后平均最高体温低于对照组（P〈0.05）。结论：保留迷走神经胃癌根治术术后血清CRP、IL-6、TNF-α蛋白水平显著降低,为保留迷走神经的胃癌根治术提供理论依据。     

腰方肌髂筋膜阻滞对全髋置换围术期的影响

[目的]评价腰方肌髂筋膜阻滞对全髋关节置换围术期炎症反应和胰岛素抵抗的影响。[方法]选取本院择期初次行单侧人工全髋关节置换术患者60例,采用随机数字表法分为两组,每组30例。常规组患者行全身麻醉,阻滞组患者行腰方肌联合髂筋膜阻滞后联合全身麻醉。比较两组临床结果。于麻醉前10 min、术后即刻、术后24 h、术后72 h抽取外周静脉血,检测两组患者血清中炎性介质C反应蛋白(CRP)、白介素-6 (IL-6)、肿瘤坏死因子α(TNF-α)水平;同时检测两组患者血清中血糖浓度和胰岛素浓度,计算胰岛素抵抗指数(IRI)。[结果]两组患者手术时间、术中失血量差异无统计学意义(P0.05);但阻滞组术中瑞芬太尼的用量显著低于常规组(P0.05)。常规组术中心律失常发生率为23.33%,而阻滞组为6.67%,差异有统计学意义(P0.05);常规组围术期不良反应发生率为33.33%,而阻滞组为13.33%,差异有统计学意义(P0.05)。两组患者的CRP、IL-6、TNF-α和IRI在术后即刻开始升高、术后24 h时达到峰值,术后72 h下降,不同时间点间的差异均有统计学意义(P0.05)。麻醉前10min两组间CRP、IL-6、TNF-α和IRI的差异无统计学意义(P0.05);但术后即刻和术后24 h时,常规组的CRP、IL-6、TNF-α和IRI均显著高于阻滞组(P0.05),至术后72 h,常规组的上述4项指标仍高于阻滞组,但差异已无统计学意义(P0.05)。[结论]腰方肌联合髂筋膜阻滞可减轻全髋关节置换围术期炎症反应,降低患者胰岛素抵抗。     

胰岛素强化治疗对胃癌根治术患者静息能量代谢的影响

目的 观察胰岛素强化治疗对胃癌根治术患者静息能量代谢的影响.方法 选取2010年1月至10月拟接受胃癌根治术的胃中、下部癌患者64例,随机分为胰岛素强化治疗组和非胰岛素强化治疗组,使手术后血糖分别控制在4.4～6.1 mmol/L和4.4～10.0 mmol/L,应用间接能量测定仪监测术前和术后第1、3、7天的静息能量消耗(REE)、呼吸商(RQ)、每千克静息能量消耗(REE/kg)和脂肪氧化供能比例的变化;测定空腹血中葡萄糖和胰岛素浓度评价胰岛素抵抗指数(HOMAIR)的改变.结果 与术前相比,两组术后第1、3天的REE、REE/kg、脂肪氧化供能比例、Ln-HOMAIR水平明显增加(P＜0.05);RQ明显下降(P＜0.05).与非胰岛素强化治疗组相比,胰岛素强化治疗明显降低术后第1、3天的REE/kg水平[(27.2±1.3)kcal/kg比(30.0±1.5)kcal/kg,P=0.008;(24.7±1.4)kcal/kg比(25.7±1.6)kcal/kg,P=0.013],降低术后第1、3天的Ln-HOMA-IR分数水平(P=0.019,0.028)和降低术后第1、3天的C反应蛋白的水平(P=0.017,0.006).胰岛素强化治疗组术后总蛋白和白蛋白水平明显高于非强化治疗组(P=0.023,0.009).结论 胰岛素强化治疗具有降低术后静息能量消耗、减少蛋白质消耗和降低胰岛素抵抗的作用.

Abstract：

Objective To investigate the effect of intensive insulin therapy on resting energy expenditure in postoperative patients underwent radical distal gastrectomy. Methods Sixty-four patients with gastric neoplasms in the middle or lower part of stomach from January to October 2010 were enrolled and underwent radical distal gastrectomy,then were randomized to intensive insulin therapy(ITT) group to keep glucose levels from 4.4 to 6.1 mmol/L or conventional insulin therapy(CIT) group to keep levels from 4.4 to 10.0 mmol/L. Resting energy expenditure (REE) ,respiratory quotient (RQ) ,resting energy expenditure per kilogram(REE/kg) and lipid oxidation ratio (LOR) were monitored by indirect energy metabolic system on preoperative and postoperative 1st, 3rd and 7th day. Fasting blood glucose and insulin concentration were measured for HOMA-IR assessment. Results Compared with preoperative baseline, postoperative REE,REE/kg,LOR,Ln-HOMA-IR increased dramatically(P ＜0.05, respectively). RQ decreased markedly(P ＜0.05). Compared with group CIT,IIT reduced the REE/kg level [(27.2 ± 1.3) kcal/kg vs. (30.0 ± 1.5)kcal/kg,P =0.008;(24.7 ±1.4) vs. (25.7 ± 1.6)kcal/kg,P =0.013]; and decreased the Ln-HOMA-IR score (P = 0.019 and 0.028) on postoperative 1st and 3rd day; IIT could decrease obviously the level of C-reaction protein level on postoperative 1st and 3rd day (P = 0.017,0.006). The total protein and albumin concentration in IIT group were more than its levels in group CIT(P = 0.023,0.009). Conclusion There are some benefits of IIT in reducing mean energy expenditure and the consumption of proteins, decreasing postoperative insulin resistance level in this small population underwent radical distal gastrectomy.     

Chemerin/ChemR23 promotes high glucose-induced IL-6 and TNF-α expressions in glomerular endothelial cells via p38 MAPK

Objective To observe the role and related mechanism of chemerin and its receptor ChemR23 in glomerular endothelial cells (GEnCs) stimulated by high glucose. Methods Mouse GEnCs were cultured and divided into control group, 20.0 mmol/L high glucose group, 40.0 mmol/L high glucose group and mannitol control group. Then the expressions of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in cell culture supernatant as well as the expressions of intracellular protein and mRNA of chemerin, ChemR23, IL-6 and TNF-α were detected. Lentiviral transfection targeting ChemR23 was applied before high glucose- or Chemerin-stimulated, and expressions of supernatant and intracellular mRNA of IL-6 and TNF-α were measured. Meanwhile whether p38 mitogen-activated protein kinase (p38 MAPK) pathway was activated by high glucose was detected. The specific inhibitor of p38 MAPK was added prior to high glucose-stimulated, then supernatant and intracellular mRNA expressions of IL-6 and TNF-α was detected. The supernatant expressions of IL-6 and TNF-α were measured by ELISA. The intracellular protein expression and p38 MAPK phosphorylation activity were detected by Western blotting. The mRNA expression was detected by real time PCR. Results Compared with those in the control group, in high glucose groups the expressions of IL-6, TNF-α and chemerin were significantly increased (all P＜0.05), however, the expressions of ChemR23 did not change (all P＞0.05); the supernatant and mRNA expressions of IL-6 and TNF-α were also elevated in the chemerin group (all P＜0.05). Lentivirus baring shRNA could efficiently suppress ChemR23 expression, and the Chemerin- or high glucose-induced expressions of IL-6 and TNF-α were reduced (all P＜0.05). Also it could significantly reduce the expression of phosphorylated-p38 MAPK (p-p38 MAPK) induced by high glucose (P＜0.05), as high glucose group had higher p-p38 MAPK than control group (P＜0.05). While the high glucose-elevated expressions of IL-6 and TNF-α were significantly attenuated by p38 MAPK inhibitor (all P＜0.05). Conclusions High glucose stimulation can induce the expression of chemerin in GEnCs. By binding to ChemR23, chemerin activates p38 MAPK signaling pathway, and then promotes the expressions of IL-6 and TNF-α. These inflammatory cytokines aggravate inflammation of GEnCs.     

胰岛素严格控制血糖对脓毒症患者的影响及其机理的初步探讨

目的　探讨用胰岛素严格控制血糖对脓毒症患者预后和并发症的影响及其可能的机理。方法　将 5 5例脓毒症患者随机分为严格控制血糖组 (用胰岛素控制血糖在 4 4～ 6 1mmol/L)和常规治疗组 (血糖控制在 10 0～ 11 1mmol/L)。在入院后的 2 4h、3d、5d和 7d、10d、14d用流式细胞仪测定外周血单核细胞HLA DR的变化 ,并同时收集炎症反应指标 ,包括血肿瘤坏死因子α(TNF α)、白细胞介素 6 (IL 6 )和C 反应蛋白 (CRP) ,以及病情严重度 (APACHEⅡ评分、SOFA评分 )、感染并发症和预后等资料 ,在两组之间进行比较。结果　相对于常规治疗组 ,严格控制血糖组体温异常持续时间、发热时间以及呼吸机辅助呼吸时间均显著缩短 (P <0 0 5 ) ,同时住院期间的ΔSOFA也显著降低(P <0 0 5 )。在严格控制血糖组有 3例 (11% )患者并发了低血糖 ,经过及时治疗未出现明显的不良后果。在感染初期单核细胞表面HLA DR表达降低、血CRP浓度增加 ,随着病程的推移HLA DR表达逐渐恢复 ,血CRP也逐渐降低。严格控制血糖组HLA DR表达的恢复较常规治疗组更快 ,入院后 3d、5和 7d存在显著差异 (P <0 0 5 ) ;同时血CRP浓度的下降也有更明显的趋势 ,在入院后 10d有显著差异 (P <0 0 5 )。结论　用胰岛素严格控制血糖能加快感染患者恢复、增     

MicroRNA-377 knockdown suppresses high glucose-induced proliferation and inflammation in human mesangial cells

Objective To investigate the effect and potential mechanism of microRNA (miRNA)-377 on high glucose-induced proliferation and inflammation in human mesangial cells. Methods Cells were randomly divided into six groups: control group (5.5 mmol/L glucose), high glucose group (30.0 mmol/L glucose), negtive miRNA inhibitor transfection+high glucose group, negtive miRNA mimic transfection+high glucose group, miRNA-377 inhibitor transfection+high glucose group (miR-377i+high glucose group), miRNA-377 mimic transfection+high glucose group (miR-377m+high glucose group). miRNA-377 expression was detected by real-time PCR. Cell proliferation and cell cycle were detected by BrdU assay and flow cytometry, respectively. The release of tumor necrosis factor-α (TNF-α), interleukin (IL)-18, IL-6 and macrophages chemotaxis protein-1 (MCP-1) were evaluated by ELISA. The activations of NF-κB pathway, including the expressions of phosporylated (p)-IκBα, p-P65 and nuclear P65, were measured by Western blotting. Results Compared with those in control group, in high glucose group cell viability, miRNA-377 expression and cell proliferation rate increased (all P＜0.05), proportions of S phase cell and G2/M phase cell in cell cycle increased (all P＜0.05), the levels of TNF-α, IL-18, IL-6 and MCP-1 were higher (all P＜0.05), as well as the expressions of p-IκBα/IκBα, p-P65/P65 and nuclear P65 were increased (all P＜0.05). Compared with high glucose group, cell proliferation rate was restrained (P＜0.05), proportions of S phase cell and G2/M phase cell in cell cycle was descreased (all P＜0.05), the levels of TNF-α, IL-18, IL-6 and MCP-1 were lower (all P＜0.05), as well as the expressions of p-IκBα/IκBα, p-P65/P65 and nuclear P65 were reduced (all P＜0.05) in miR-377i+high glucose group. However, miR-377m+high glucose group presented opposite results (all P＜0.05). Conclusions miRNA-377 knockdown can partially suppress high glucose-induced human mesangial cell proliferation and cell cycle transition, and restrain inflammatory molecules release. Its mechanism may be related to the inhibition of NF-κB pathway.     

胃转流术对2型糖尿病大鼠的降糖作用及对糖耐量和胰岛素抵抗的影响

目的 观察胃转流术(CBP)对2型糖尿病大鼠的降糖效果及对糖耐量和胰岛素抵抗的影响.方法 将健康雄性SD大鼠随机分为正常组(NO组,n=10)和造模组(n=32).成模大鼠随机分为糖尿病手术组(DO组)、假手术组(DS组)和对照组(DC组),每组8只.检测手术前后各组空腹血糖、胰岛素、口服葡萄糖30min后的血糖及胰岛素抵抗指数(HOMA-IR).检测DO组术前与术后第4周口服葡萄糖耐量实验后0、10、30、60、120、180 min血糖,计算糖耐量曲线下面积.结果DO组GBP术后第8周空腹血糖由术前的(17.80±2.26)mmol/L下降到(6.18±0.53)mmol/L(P<0.05),NO组手术前后空腹血糖无明显变化.口服葡萄糖30 min后血糖DO组下降更为明显,由术前的(29.20±1.46)mmol/L至术后第8周下降到(13.55±0.86)mmol/L(P<0.05).术后4周DO组各时间点OGTT曲线下面积(AUC)下降约40.1%.DO组术后8周HOMA-IR明显下降,由术前的9.36±0.90下降至4.03±0.34(P<0.05).结论 胃转流术能明显降低2型糖尿病大鼠的血糖水平,且能明显改善糖耐量和胰岛素抵抗,并对正常血糖值无影响.     

不同胃肠吻合方式对非肥胖型2型糖尿病大鼠的降糖作用

目的 观察不同胃肠吻合方式对非肥胖型2型糖尿病(T2DM)大鼠的治疗作用.方法 将24只雄性Goto-Kakizaki(GK)大鼠随机分3组,分别为Roux-en-Y式、毕Ⅱ式胃转流术组和毕Ⅰ式组,每组8只.检测术前(0周)及术后1、3、6、12、24周空腹血糖及空腹血清胰岛素水平,采用稳态模型法计算胰岛素抵抗指数(HOMA-IR).结果 与术前比较,毕Ⅰ式组空腹血糖、空腹胰岛素、HOMA-IR术后1～24周未见明显变化(P＞0.05):而Roux-en-Y式、毕Ⅱ式组术后1～24周空腹血糖较术前显著降低(P＜0.01),术后24周,空腹血糖由(12.56±2.97)、(12.96±3.01)mmol/L下降到(7.87±0.75)、(9.21±1.53)mmol/L;空腹胰岛素术后1～24周未见明显变化(P＞0.05),HOMA-IR术后1～24周显著降低(P＜0.01),术后24周,HOMA-IR由(11.92±1.45)、(12.69±2.03)下降到(6.66±1.25)、(7.97±0.68).结论 毕Ⅰ式胃肠吻合术对2型糖尿病大鼠可能无治疗作用,Roux-en-Y式和毕Ⅱ式胃转流术可改善2型糖尿病大鼠胰岛素抵抗程度,有效控制血糖水平,且Roux-en-Y式胃转流术疗效优于毕Ⅱ式胃转流术.

Abstract：

Objective To investigate the effect after gastrojejunostomy with different types of anastomosis in an animal model of nonobese type 2 diabetes.Methods Twenty-four Goto-Kakizaki rats randomly underwent one of the following procedures:gastric bypass with different types of anastomosis of Roux-en-Y ( n = 8),Billroth Ⅱ ( n = 8 ) or Billroth Ⅰ ( n = 8 ).Rats were observed for 24 weeks after surgery.Fasting blood glucose and insulin level were tested at 0,1,3,6,12,24 weeks and homeostasis model assessment of insulin resistance (HOMA-IR) was done.Results As compared with preoperation,fasting blood glucose levels,the fasting blood insulin level and the HOMA-IR level had no significant change in Billroth Ⅰ rats during the entire follow-up period ( P ＞ 0.05).In both Roux-en-Y and Billroth Ⅱ groups,fasting blood glucose levels were significantly decreased as early as 1 week after surgery and then kept a similar level during the entire follow-up period (P＜0.01 ).Twenty-four weeks after operation,the fasting blood glucose levels was declined from (12.56 ±2.97),(12.96 ±3.01) mmol/L to (7.87 ±0.75),(9.21 ± 1.53) mmol/L;the fasting blood insulin levels were similar during the entire follow-up period ( P ＞0.05 ).The HOMA-IR level was significantly decreased after surgery in both Roux-en-Y and Billroth Ⅱ groups during the follow-up period ( P＜0.01 ).Twenty-four weeks after operation,the HOMA-IR level was declined from (11.92 ± 1.45),(12.69 ±2.03) to (6.66 ± 1.25),(7.97 ±0.68).Conclusion Billroth Ⅰ reconstruction after gastrectomy is not effective on diabetes control.Roux-en-Y and Billroth Ⅱ gastric bypass in a nonobese diabetic model were effective in terms of glucose control and improving insulin resistance.But Roux-en-Y gastric bypass seems to be more effective than Billroth Ⅱ gastric bypass on antidiabetes.     

腹腔镜脾切除术治疗巨脾症的临床疗效及其对病人应激反应的影响

目的探讨腹腔镜脾切除术治疗巨脾症的临床疗效及其对病人应激反应的影响。方法将汉川市人民医院2013年1月至2016年6月收治的38例巨脾症病人作为临床研究对象,根据其治疗方式,将19例行腹腔镜脾切除术(laparoscopic splenectomy,LS)病人纳入LS组,19例行开腹脾切除术(open splenectomy,OS)病人纳入OS组,记录两组病人手术切口长度、手术时间、术中出血量、肠功能恢复时间、住院时间及术后并发症发生情况,并检测两组病人术前1 d、术后1 d及7 d C反应蛋白(C-reactive protem,CRP)、降钙素原(procalcitonin,PCT)、白细胞介素6(interleukin-6,IL-6)、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)等应激反应指标并观察其变化,给予统计学分析后得出结论。结果除手术时间外,在手术切口长度、术中出血量、住院时间、肠道功能恢复时间、术后并发症发生率等比较中,LS组均优于OS组,差异均有统计学意义(P0.05)。在应激反应指标方面,两组病人术后1 d CRP、PCT、IL-6、TNF-α均明显升高,术后7d均明显降低,但两组病人之间比较,LS组术前1d与OS组差异无统计学意义,术后1 d、7 d均明显低于OS组,差异均有统计学意义(P0.05)。结论在巨脾症的临床治疗中,LS对病人术中侵袭度小,术后恢复快,对病人应激反应影响小,术后并发症少。