术前口服碳水化合物对结直肠癌根治术患者肠促胰岛素和胃泌素水平的影响
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摘要
目的探讨术前口服碳水化合物对结直肠癌根治术患者肠促胰岛素和胃泌素水平的影响。方法将60例行结直肠癌根治术的患者随机分为试验组和对照组,各30例。试验组术前2 h口服碳水化合物,对照组禁饮食。比较两组患者手术前、后的血糖、胰岛素水平、胰岛素抵抗指数(HOMA-IR)、肠促胰岛素[葡萄糖依赖性促胰岛素分泌多肽(GIP)、胰高血糖素样肽1(GLP-1)]和胃泌素(GAS)水平。结果手术开始前5 min,试验组血糖、胰岛素、GIP、GLP-1及GAS水平升高且均高于对照组(P<0.05);手术后,两组的血糖及胰岛素水平均高于手术开始前5 min,但试验组低于对照组(P<0.05)。与手术前比较,手术后两组的HOMA-IR均升高,但试验组低于对照组(P<0.05)。手术后,试验组GIP、GLP-1及GAS水平均降低(P<0.05);但两组间比较,差异无统计学意义(P>0.05)。结论术前口服碳水化合物可有效提高结直肠癌患者的GIP、GLP-1及GAS水平,其可刺激胰岛素的释放,改善胰腺β细胞的功能,保证胰腺功能的稳定,从而改善患者术后胰岛素抵抗。
Objective To investigate the effect of preoperative oral carbohydrates on levels of incretin and gastrin in patients undergoing radical resection of colorectal cancer. Methods Sixty patients undergoing radical resection of colorectal cancer were randomly divided into experimental group and control group, with 30 cases in each group. The experimental group was given oral carbohydrates at preoperative 2 h, while the control group was forbidden to eat. The levels of blood sugar, insulin, insulin resistance index(HOMA-IR), incretin [glucose-dependent insulinotropic peptide(GIP), glucagon-like peptide 1(GLP-1)] and gastrin(GAS) before and after operation were compared between the two groups. Results At 5 minutes before operation, the levels of blood sugar, insulin, GIP, GLP-1 and GAS in the experimental group increased and were higher than those in the control group(P <0.05). After operation, the levels of blood sugar and insulin in the two groups were higher than those at 5 minutes before operation, but those in the experimental group were lower than the control group(P<0.05). After operation, the HOMA-IR of both groups were higher than that before operation, but that of the experimental group was lower than the control group(P<0.05). After operation, the levels of GIP, GLP-1 and GAS in the experimental group decreased(P<0.05), but there were no significant differences between the two groups(P>0.05).Conclusion Preoperative oral carbohydrates can effectively improve the levels of GIP, GLP-1 and GAS in patients with colorectal cancer, which can stimulate insulin release, improve the function of pancreatic β cells, ensure the stability of pancreatic function, and improve insulin resistance after operation.
Objective To investigate the effect of preoperative oral carbohydrates on levels of incretin and gastrin in patients undergoing radical resection of colorectal cancer. Methods Sixty patients undergoing radical resection of colorectal cancer were randomly divided into experimental group and control group, with 30 cases in each group. The experimental group was given oral carbohydrates at preoperative 2 h, while the control group was forbidden to eat. The levels of blood sugar, insulin, insulin resistance index(HOMA-IR), incretin [glucose-dependent insulinotropic peptide(GIP), glucagon-like peptide 1(GLP-1)] and gastrin(GAS) before and after operation were compared between the two groups. Results At 5 minutes before operation, the levels of blood sugar, insulin, GIP, GLP-1 and GAS in the experimental group increased and were higher than those in the control group(P <0.05). After operation, the levels of blood sugar and insulin in the two groups were higher than those at 5 minutes before operation, but those in the experimental group were lower than the control group(P<0.05). After operation, the HOMA-IR of both groups were higher than that before operation, but that of the experimental group was lower than the control group(P<0.05). After operation, the levels of GIP, GLP-1 and GAS in the experimental group decreased(P<0.05), but there were no significant differences between the two groups(P>0.05).Conclusion Preoperative oral carbohydrates can effectively improve the levels of GIP, GLP-1 and GAS in patients with colorectal cancer, which can stimulate insulin release, improve the function of pancreatic β cells, ensure the stability of pancreatic function, and improve insulin resistance after operation.
引文
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[3]王智浩.术前口服碳水化合物对胃癌根治术患者胰腺β细胞功能影响的随机临床研究[D].青岛:青岛大学,2013.
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[7] MACIEJEWSKI BS,MANION TB,Steppan CM.Pharmacological inhi-bition of diacylglycerol acyltransferase-1 and insights into postpran-dial gut peptide secretion[J].World J Gastrointest Pathophysiol,2017,8(4):161-175.
[2]张力君,徐林,刘乐阳,等.术前口服碳水化合物对改善结直肠癌术后胰岛素抵抗的影响[J].云南医药,2017,38(5):478-480.
[3]王智浩.术前口服碳水化合物对胃癌根治术患者胰腺β细胞功能影响的随机临床研究[D].青岛:青岛大学,2013.
[4] WU T,RAYNER CK,HOROWITZ M.Inter-regulation of gastric emp-tying and incretin hormone secretion:implications for postprandialglycemic control[J].Biomark Med,2016,10(11):1167-1179.
[5] ADAMSKA E,OSTROWSKA L,G RSKA M,et al.The role of gas-trointestinal hormones in the pathogenesis of obesity and type 2 dia-betes[J].Prz Gastroenterol,2014,9(2):69-76.
[6] MADSBAD S.The role of glucagon-like peptide-1 impairment inobesity and potential therapeutic implications[J].Diabetes ObesMetab,2014,16(1):9-21.
[7] MACIEJEWSKI BS,MANION TB,Steppan CM.Pharmacological inhi-bition of diacylglycerol acyltransferase-1 and insights into postpran-dial gut peptide secretion[J].World J Gastrointest Pathophysiol,2017,8(4):161-175.