目的

探讨胰岛素强化治疗对胃癌患者术后胰岛素抵抗（IR）的影响。

方法

将22例胃癌患者随机分为胰岛素强化治疗组和对照组各11例，均在硬膜外麻醉下行根治性远端胃次全切除术，分别于术前和术后第1、3、7天测量空腹血糖（FBG）、胰岛素（FINS）、C-反应蛋白（CRP），使用稳态模式评估法（homeostasis model assessment, HOMA） 计算胰岛素抵抗指数（HOMA-IR），利用多元相关分析法分析术后HOMA-IR的相关因素。

结果

胰岛素强化治疗能明显降低胃癌术后患者的FBG、FINS、lnHOMA-IR（FBG、lnHOMA-IR P<0.01,FINS P<0.05）及IR发生率；强化治疗组患者术后CRP水平明显低于对照组（P<0.05）；lnHOMA-IR与体重指数（BMI）、FINS高度正相关（P<0.01）。

结论

胰岛素强化治疗能降低胃癌术后患者的胰岛素抵抗，减轻患者术后的炎性反应。

Objective

To investigate the influence of intensive insulin therapy on insulin resistance (IR)after distal radical gastrectomy.

Methods

22 gastric gancer patients were randomly divided into intensive insulin therapy group and control group (n=11),and underwent distal radical subtotal gastrectomy under epidural anesthesia. Fasting blood glucose (FBG), fasting serum insulin (FINS) and C-reactive protein（CRP）levels were assayed preoperatively and on 1st,3rd,7th day postoperatively.Insulin resistance index was calculated using homeostasis model assessment (HOMA),and the related factors were analysed by bivariate correlation method.

Results

The levels of FBG，FINS，lnHOMA-IR (P<0.05)and the incidence rate of IR were decreased significiantly in the patients underwent radical subtotal gastrectomy.The postoperative concentration of CRP of patients in intensive insulin therapy group were remarkably lower than that in control group(P<0.05).The body mass index(BMI)and FINS level were highly positively correlated with index of IR(P<0.01).

Conclusion

Compared with routine therapy,the intensive insulin therapy has more benefits to decrease insulin resistance and reduce inflammatory reaction after gastric cancer operation.