糖预处理法对大肠癌患者术后胰岛素抵抗和血清肿瘤坏死因子受体的影响

目的观察大肠癌患者术前采用糖预处理和新的禁食方法,对患者术后胰岛素抵抗(IR)和肿瘤坏死因子受体1(sTNFR1)和肿瘤坏死因子受体2(sTNFR2)含量的影响。方法选取大肠癌患者51例,分为对照组(24例)和治疗组(27例)。对照组按外科常规处理,治疗组采用新的禁食方法和糖预处理法,并严格控制患者术后血糖水平。测定患者术前、术毕及术后1、4和7d的胰岛素敏感性(SI)、血清sTNFR1和sTNFR2的含量,同时记录患者的体重指数(BMI)、排气时间和住院天数等指标。结果排气时间和住院天数治疗组较对照组明显缩短(P<0.05)。治疗组术后SI无改变(P>0.05),对照组术后SI明显低于术前(P<0.05)。对照组sTNFR1含量术后无明显改变(P>0.05),而sTNFR2含量从术后1d明显增高(P<0.05),到术后7d仍未恢复。治疗组的sTNFR1含量术后明显增高于术后1d到最高峰,术后7d的水平仍高于术前(P<0.05);同期比较术后治疗组sTNFRI含量明显高于对照组(P<0.05);同组患者sTNFR2含量自术毕就显著低于术前水平,到术后7d仍未恢复,差异有统计学意义(P<0.05)。结论新的禁食方法和糖预处理法可以安全用于大肠癌患者,并能有效降低术后IR程度,缩短IR时间,提高TNF-α抗肿瘤效能,减少患者住院天数,有助于患者的预后。

The effects of preoperative carbohydrate loading on the changes in sTNFR1,sTNFR2 and insulin resistance in patients with colon carcinoma

Objective A study was carried out to determine the effects of preoperative carbohydrate loading and new fasting protocol treatment on postoperative changes in serum tumor necrosis factor receptor1(sTNFR1),serum tumor necrosis factor receptor2(sTNFR2)and insulin resistance in patients with colon carcinoma.Methods 51 patients were treated with either a carbohydrate-rich beverage(n=24)or placebo(n=27)before undergoing colon carcinoma surgery.Insulin sensitivity(SI),sTNFR1,sTNFR2 were measared before operation,1,4,7 day postoperation respectively,and BMI the time of first flatus and hospital day were recoreded as well.Results There was not different to S1 in the treatment group(P>0.05).Postoperative SI was significantly lower than that of pre-operation in control group(P<0.05).In the treatment group the sTNFR1in the serum increased at postoperative and did not recover in seven days after operation(P<0.05).While the lever of sTNFR2 decreased until seven days after operate.The change of the sTNFR2 in the control group increase after operate(P<0.05).There was not different of the sTNFR1 in the control group either preoperative or postoperative(P>0.05).The time to first flatus and days staying in hospital in treatment group were significantly reducing comparing to placebo group(P<0.05).Conclusion Preoperative carbohydrate loading and new fasting protocol can reduce the degree and course of insulin resistance and increase the sTNFR1and decrease the sTNFR2.It also can decrease days of patients staying in hospital and increase recovery of patients.