摘要
目的 观察体外循环和非体外循环手术中骨骼肌胰岛素受体TPK活性及血浆TNF α改变 ,探讨胰岛素抵抗产生的机制。方法 随机选择 8例动脉导管患者及 1 5例房缺或室缺患者 ,于麻醉前、麻醉后、开胸后 2 0min、术毕、术后 6h采取血样 ,测定血糖、胰岛素、TNF α的浓度 ,并于手术开始即刻、术毕关胸即刻取骨骼肌标本 ,测定胰岛素受体酪氨酸蛋白激酶 (TPK)活性的变化。结果 体外循环组血糖、胰岛素、TNF α均明显升高 ,手术结束时骨骼肌胰岛素受体TPK活性明显低于手术开始时。动脉导管组血糖明显升高 ,胰岛素及TNF α有所升高 ,但不显著 ,手术前后骨骼肌胰岛素受体TPK活性无明显改变。结论 体外循环手术机体胰岛素抵抗程度明显强于非体外循环手术 ,体外循环可作为一个独立损伤因素影响胰岛素受体TPK活性从而干扰了胰岛素的正常信号传导 ,产生明显的胰岛素抵抗 ,TNF
Objective To investigate the perioperative changes of insulin receptor tyrosine kinase(TPK) activity in skeletal muscle and tumor necrosis factor α(TNF α) in plasma in patients underwent cardiopulmonary bypass(CPB) and Non CPB operations,and to explore the mechanism of insulin resistance.Methods Blood samples were obtained before anesthesia,after anesthesia,20min after opening thorax,at the end of operation,6h after operation.Glucose,insulin as well as TNF α were measured.The skeletal muscle samples were obtained at the beginning and the end of operation.Then the activity of insulin receptor tyrosine protein kinase of skeletal were assayed.Results In CPB group,the levels of plasma glucose,insulin and TNF α elevated significantly during operation and the activity of insulin receptor TPK in skeletal muscle with insulin stimulation was greatly reduced at the end of operation compared with the beginning of operation.In non CPB group,only glucose elevated significantly and no significant changes in activity of insulin receptor TPK and its sensitivity to insulin stimulation in skeletal muscle were observed.Conclusion The surgery with CPB might cause more serious insulin resistance than surgery without CPB.And the process of CPB could be an independent factor to effect the function of insulin receptor TPK and intervene insulin signal transduction. TNF α could play an important role in this process during opertion with CPB.
出处
《重庆医学》
CAS
CSCD
2003年第8期968-970,976,共4页
Chongqing medicine
关键词
体外循环
胰岛素抵抗
酪氨酸蛋白激酶
肿瘤坏死因子
cardiopulmonary bypass
insulin resistance
tyrosine protein kinase(TPK)
tumor necrosis factor α(TNF α)
