摘要
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）和血清肿瘤坏死因子受体（sTNFR）1和sTNFR2含量的影响。方法选取大肠癌患者51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。测定患者术前、术毕及术后1d、4d和7d的胰岛素敏感性（S1）、血清sTNFR1和sTNFR2的含量，同时记录患者的BMI、排气时间和住院天数等指标。结果治疗组术后S1无变化（P〉0．05），而对照组S1显著降低（P〈0．05）。对照组患者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，到术后7d仍未恢复。治疗组患者的sTNFR1含量增高到术后1d达最高峰，术后7d仍高于术前（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，（P〈0．05）。治疗组患者的排气时间和住院天数也明显缩短（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，并能有效改善术后IR，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。
Objective To investigate the effects of preoperative carbohydrate loading and new fasting protocol treatment on the postoperative changes in serum tumor necrosis factor receptorl （ sTNFR1 ） , sTNFR2, and insulin resistance （IR） in patients of colon carcinoma. Methods 51 patients of colon carcinoma were randomly divided into 2 groups： carbohydrate-rich beverage group （n = 24）, undergoing fasting 6 h before operation and water deprivation 2 h before operation, receiving carbohydrate-rich beverage 3 h before operation and fluid therapy with glucose post-operatively, and placebo group （ n = 27 ） undergoing routine fasting and water deprivation pre-operatively. Peripheral blood samples were collected before, during, and 1, 4, and 7 d after operation. ELISA was used to detect the sTNFR1 and sTNFR2 of preoperative, 1, 4,7day Insulin sensitivity index （S1） was calculated. Results The S1 levels at different post-operational time points of the treatment group were not significantly different from those preoperatively （ all P 〉 0. 05 ） , while the S1 levels of the control group decreased significantly compared to those before operation（all P 〈 0. 05）. The sTNFR1 level of the treatment group increased postoperatively and did not return to the pre-operative level 7 d after operation （ all P 〈 0. 05 ）. The sTNFR1 levels at different postoperative time points of the treatment group were all significantly higher than those of the control group （ all P 〈 0. 05）. The sTNFR2 level of the treatment group decreased postoperatively and did not return to the preoperative level 7d after operation（ all P 〈 0. 05 ）. The sTNFR2 levels at different post-operative time points of the treatment group were all significantly lower than those of the control group （ all P 〈 0.05 ）. There was not significant differences in the sTNFR1 level in the control group before and after operation （ all P 〉 0. 05 ）. The time to first flatus and days staying in hospital of the treatment group were （77±15） hours and （11±1.2 ） gays respectively, both significantly shorter than those of the control group [ （86±13） hours and （ 15. 1±3.8 ） days respectively, both P 〈 0. 05 ]. Conclusion Preoperative carbohydrate loading and new fasting protocol reduce the degree and course of IR, increase the sTNFR1 level, and decrease the sTNFR2 level and days of staying in hospital.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2008年第29期2041-2044,共4页
National Medical Journal of China
基金
河北省普通高校强势特色学科建设基金资助项目[2005]52
河北省卫生厅重点科研基金资助项目（06099）
关键词
结肠肿瘤
受体
肿瘤坏死因子
胰岛素抵抗
糖预处理
Colonic neoplasms
Receptors, tumor necrosis factor
Insulin resistance
Preoperative carbohydrate loading
