目的

观察胃癌术后胰岛素抵抗（insuline resistance，IR）的发生特点，寻找影响术后IR的因素。

方法

随机选择拟手术的胃癌病人51例为研究对象，进行人体测量，并利用双能源X线吸收法测定病人人体组成，检测术前和术后第1天空腹血糖、胰岛素、白蛋白、转铁蛋白、前白蛋白、维A结合蛋白、IgG、IgA、IgM、C3和C4等营养及免疫指标。使用稳态模式评估法（homeostasis model assessment，HOMA）计算胰岛素抵抗指数（HOMA-IR）。

结果

胃癌术后IR的发生率为49.02%，IR指数与体重、体质指数、腰围、臀围、腰臀比和脂肪密切相关，腰围与IR状态的回归关系明显，腰围对是否发生IR估计的正确率为72.5%。术后第1天血糖、胰岛素、腰围与IR指数呈独立正相关。

结论

胃癌术后病人存在IR，与体重、腰围、臀围、腰臀比、体质指数和脂肪含量呈明显正相关。术后第1天血糖、胰岛素和腰围是能够反映术后IR的重要因素，腰围是能够预测IR的较为简单易行的指标。

Objective

To observe the epidemiological features of insulin resistance on postoperative patients with gastric cancer，and evaluate the relationship between insulin resistance and clinical parameters.

Methods

51 patients with gastric cancer were selected randomly to measure body anthropometry and body composition by dual-energy X-ray absorptiometry（DEXA）after hospitalization.Fasting blood glucose（FBG），fasting insulin（FINS），visceral proteins and immunologic index including albumin（ALB），prealbumin（PRE），transferring（TRF），retinal-binding protein（RBP），IgG，IgA，IgM，C3 and C4 were detected before operation and on the first day after operation.Insulin resistance was evaluated by the method of homeostasis model assessment（HOMA）.

Results

The incidence of IR in gastric cancer patients was 49.02%postoperatively，lnHOMA-IR was positively correlated with patients weight，BMI，waist circumference，hip circumference，waist to hip ratio（WHR）and body fat.waist circumference was correlated with IR in this model，and the accuracy was 72.5%.FINS，FBG and waist circumference were independently positively correlated with lnHOMA-IR.

Conclusion

Insulin resistance exist in gastric cancer postoperatively，lnHOMA-IR was positively correlated with weight，BMI，waist circumference，hip circumference，WHR and body fat.FINS，FBG and waist circumference on the first day postoperatively are important to reflect IR.Waist circumference is a convenient and simple index to estimate IR.