创伤手术后胰升血糖素样肽-1的变化及其对糖代谢的影响

目的探讨创伤手术后胰升血糖素样肽-1的变化及其对糖代谢的影响。方法通过大手术患者及动物实验〔分为对照组、手术组和胰升血糖素样肽-1(GLP-1)组〕,观察手术前、手术后1、3、5dGLP-1、胰岛素(I)、胰升血糖素(G),血糖等的变化及静脉输注GLP-1对它们的影响。结果手术后患者第1dI、G及血糖均明显升高(P<0.01),I/G比值也明显升高(P<0.05),而GLP-1在手术后第3d才明显升高(P<0.05)。大鼠肝切除后第1、3、5d血糖、G较对照组明显升高(P<0.001,P<0.05),而I则明显下降(P<0.001),致I/G比值在术后明显下降(P<0.001);GLP-1组第1d血糖、I、G与手术组比较无明显差异(P>0.05),第3、5d血糖、G明显低于手术组(P<0.001,P<0.05),而I明显高于手术组(P<0.001),致I/G比值明显高于手术组(P<0.001)。结论大手术后患者存在明显糖代谢紊乱;大鼠肝切除后早期GLP-1促进胰岛素分泌和抑制胰升血糖素释放的作用减弱,随着术后时间的延长,应激程度减轻,GLP-1促进胰岛素分泌和抑制胰升血糖素释放的作用增强,机体利用葡萄糖能力随之提高,血糖水平下降。

The Change of Glucagon-like Peptide-1 and Its Effect on Blood Glucose Metabolism after Major Surgery

Objective To investigate the change of glucagon-like peptide-1(GLP-1)and its effect on blood glucose metabolism after major surgery.Methods Eleven patients,who had undergone major surgical procedures in our Department of General Surgery,were studied on the day before surgery,the first,third,and fifth day after surgery.Then,42 rats were allocated randomly into three groups.The rats in control,which had not undergone any operation,received an intravenous glucose load(0.5 g/kg glucose normal saline).The rats in operated group,which had undergone about 65% liver resection,received a same glucose load on the first,third,and fifth postoperative day.And the rats in GLP-1 group,which had undergone same hepatectomy,received a same glucose load with GLP-1(0.3 nmol/kg)on the first,third,and fifth day after surgery.All rats would be killed by abdominal aorta exsanguinated in five minutes after drugs were infused of which the bloods were collected for determination of glucose(glucose oxidase),insulin,glucagon,and GLP-1(radioimmunoassays)at each time-point.Results There was an increasing postoperative plasma concentration of glucose,insulin,and glucagon on the first day(P<0.01),but the plasma GLP-1 was just elevated on the third day(P<0.05).Then,the plasma glucose concentration was significantly lowered after GLP-1 given to rats undergoing hepatectomy(P<0.001),which might reach the glucose range in controls.Lowering of blood glucose was achieved by a significant rise of insulin secretion(P<0.001)and a suppression of glucagon secretion(P<0.05).Conclusion As far as can be concluded on basis of our data from patients and rats,GLP-1 can be used to reduce the plasma glucose concentrations when it is in stress status after major surgery.