Clinical Study of Insulin Resistance for Patients after Selective Operation in Department of General Surgery_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Di , CHE Xiangming , LI Haijun , GAN Jianxin , ZHANG Danjie , LIAO Xinhua.

Department of General Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, China;

Corresponding author：

Keywords：

Insulin resistance; Homeostasis model assessment; General surgery; Selective operation

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the risk factors for insulin resistance (IR) after selective operation in the department of general surgery.
Methods Two hundred and sixty-three patients including 122 males and 141 females after selective operation between March 2009 and October 2009 in The First Affiliated Hospital of Xi’an Jiaotong University were studied. Sex, age, histories of smoking and drinking, hypertensive disease, history of operation, height, weight, waist circumference, anesthesia method, operation duration, operation method, and volumes of transfusion and liquid injection during operation were recorded. The fasting blood glucose (BG) and fasting plasma insulin (INS) were tested for selectively operative patients on day 1 before and after surgery. Insulin resistance index (HOMA-IR) and the index of insulin secretion (HOMA-β) were calculated with homeostasis model assessment (HOMA). Logarithms of HOMA-IR (lnHOMA-IR) was taken because that HOMA-IR was not normal distribution.
Results The levels of fasting BG, fasting plasma INS, and lnHOMA-IR on day 1 after operation were higher than those on day 1 before operation (P lt;0.001). IR was correlated with patients’ sex (P=0.002), the history of smoking (P=0.033), waist circumference (P=0.000), operation method (P=0.007), and the volume of liquid injection during operation (P=0.001). A significant elevation of the change of lnHOMA-IR level was found between abdominal and nonabdominal surgery (P lt;0.001).
Conclusions IR occurs in selectively operative patients in the department of general surgery. It is helpful for depressing IR to control the intensity of surgery.

Citation： ZHANG Di,CHE Xiangming,LI Haijun,GAN Jianxin,ZHANG Danjie,LIAO Xinhua.. Clinical Study of Insulin Resistance for Patients after Selective Operation in Department of General Surgery. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(9): 951-954. doi: Copy

1.	Lee S, Muniyappa R, Yan X, et al. Comparison between surrogate indexes of insulin sensitivity and resistance and hyperinsulinemic euglycemic clamp estimates in mice [J]. Am J Physiol Endocrinol Metab, 2008; 294(2): E261E270.
2.	Thorell A, Nygren J, Hirshman MF, et al. Surgeryinduced insulin resistance in human patients: relation to glucose transport and utilization [J]. Am J Physiol, 1999; 276(4 Pt 1): E754E761.
3.	Thorell A, Nygren J, Essén P, et al. The metabolic response to cholecystectomy: insulin resistance after open compared with laparoscopic operation [J]. Eur J Surg, 1996; 162(3): 187191.
4.	Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome [J]. Lancet, 2005; 365(9468): 14151428.
5.	Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and betacell function from fasting plasma glucose and insulin concentrations in man [J]. Diabetologia, 1985; 28(7): 412419.
6.	Lewis KS, KaneGill SL, Bobek MB, et al. Intensive insulin therapy for critically ill patients [J]. Ann Pharmacother, 2004; 38(78): 12431251.
7.	Mather KJ, Hunt AE, Steinberg HO, et al. Repeatability characteristics of simple indices of insulin resistance: implications for research applications [J]. J Clin Endocrinol Metab, 2001; 86(11): 54575464.
8.	Orford NR. Intensive insulin therapy in septic shock [J]. Crit Care Resusc, 2006; 8(3): 230234.
9.	DeFronzo RA, Tobin JD, Andres R. Glucose clamp technique: a method for quantifying insulin secretion and resistance [J]. Am J Physiol, 1979; 237(3): E214E223.
10.	Malita FM, Karelis AD, StPierre DH, et al. Surrogate indexes vs. euglycaemichyperinsulinemic clamp as an indicator of insulin resistance and cardiovascular risk factors in overweight and obese postmenopausal women [J]. Diabetes Metab, 2006; 32(3): 251255.
11.	燕晓雯, 李维勤, 虞文魁, 等. 外科感染患者胰岛素抵抗及其相关因素分析 [J]. 外科理论与实践， 2006; 11(1): 1419.
12.	Greisen J, Juhl CB, Grfte T, et al. Acute pain induces insulin resistance in humans [J]. Anesthesiology, 2001; 95(3): 578584.
13.	Moller DE, Flier JS. Insulin resistance-mechanisms, syndromes, and implications [J]. N Engl J Med, 1991; 325(13): 938948.
14.	Anai M, Funaki M, Ogihara T, et al. Altered expression levels and impaired steps in the pathway to phosphatidylinositol 3kinase activation via insulin receptor substrates 1 and 2 in Zucker fatty rats [J]. Diabetes, 1998; 47(1): 1323.
15.	Arner P. Insulin resistance in type 2 diabetes-role of the adipokines [J]. Curr Mol Med, 2005; 5(3): 333339.
16.	GuerreMillo M, Rouault C, Poulain P, et al. PPARαnull mice are protected from highfat dietinduced insulin resistance [J]. Diabetes, 2001; 50(12): 28092814.
17.	Uranga AP, Levine J, Jensen M. Isotope tracer measures of meal fatty acid metabolism: reproducibility and effects of the menstrual cycle [J]. Am J Physiol Endocrinol Metab, 2005; 288(3): E547E555.
18.	Votruba SB, Jensen MD. Sexspecific differences in leg fat uptake are revealed with a highfat meal [J]. Am J Physiol Endocrinol Metab, 2006; 291(5): E1115E1123.
19.	Kuhl J, Hilding A, Ostenson CG, et al. Characterisation of subjects with early abnormalities of glucose tolerance in the Stockholm Diabetes Prevention Programme: the impact of sex and type 2 diabetes heredity [J]. Diabetologia, 2005; 48(1): 3540.
20.	Laughlin GA, BarrettConnor E, May S. Sexspecific association of the androgen to oestrogen ratio with adipocytokine levels in older adults: the Rancho Bernardo Study [J]. Clin Endocrinol (Oxf), 2006; 65(4): 506513.
21.	Lee CC, KasaVubu JZ, Supiano MA. Androgenicity and obesity are independently associated with insulin sensitivity in postmenopausal women [J]. Metabolism, 2004; 53(4): 507512.
22.	Livingstone C, Collison M. Sex steroids and insulin resistance [J]. Clin Sci (Lond), 2002; 102(2): 151166.
23.	王治国, 杨喆, 秦环龙, 等. 术前口服碳水化合物改善术后胰岛素抵抗的作用及其机理研究 [J]. 中国普外基础与临床杂志, 2008; 15(11): 799804.

1. Lee S, Muniyappa R, Yan X, et al. Comparison between surrogate indexes of insulin sensitivity and resistance and hyperinsulinemic euglycemic clamp estimates in mice [J]. Am J Physiol Endocrinol Metab, 2008; 294(2): E261E270.
2. Thorell A, Nygren J, Hirshman MF, et al. Surgeryinduced insulin resistance in human patients: relation to glucose transport and utilization [J]. Am J Physiol, 1999; 276(4 Pt 1): E754E761.
3. Thorell A, Nygren J, Essén P, et al. The metabolic response to cholecystectomy: insulin resistance after open compared with laparoscopic operation [J]. Eur J Surg, 1996; 162(3): 187191.
4. Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome [J]. Lancet, 2005; 365(9468): 14151428.
5. Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and betacell function from fasting plasma glucose and insulin concentrations in man [J]. Diabetologia, 1985; 28(7): 412419.
6. Lewis KS, KaneGill SL, Bobek MB, et al. Intensive insulin therapy for critically ill patients [J]. Ann Pharmacother, 2004; 38(78): 12431251.
7. Mather KJ, Hunt AE, Steinberg HO, et al. Repeatability characteristics of simple indices of insulin resistance: implications for research applications [J]. J Clin Endocrinol Metab, 2001; 86(11): 54575464.
8. Orford NR. Intensive insulin therapy in septic shock [J]. Crit Care Resusc, 2006; 8(3): 230234.
9. DeFronzo RA, Tobin JD, Andres R. Glucose clamp technique: a method for quantifying insulin secretion and resistance [J]. Am J Physiol, 1979; 237(3): E214E223.
10. Malita FM, Karelis AD, StPierre DH, et al. Surrogate indexes vs. euglycaemichyperinsulinemic clamp as an indicator of insulin resistance and cardiovascular risk factors in overweight and obese postmenopausal women [J]. Diabetes Metab, 2006; 32(3): 251255.
11. 燕晓雯, 李维勤, 虞文魁, 等. 外科感染患者胰岛素抵抗及其相关因素分析 [J]. 外科理论与实践， 2006; 11(1): 1419.
12. Greisen J, Juhl CB, Grfte T, et al. Acute pain induces insulin resistance in humans [J]. Anesthesiology, 2001; 95(3): 578584.
13. Moller DE, Flier JS. Insulin resistance-mechanisms, syndromes, and implications [J]. N Engl J Med, 1991; 325(13): 938948.
14. Anai M, Funaki M, Ogihara T, et al. Altered expression levels and impaired steps in the pathway to phosphatidylinositol 3kinase activation via insulin receptor substrates 1 and 2 in Zucker fatty rats [J]. Diabetes, 1998; 47(1): 1323.
15. Arner P. Insulin resistance in type 2 diabetes-role of the adipokines [J]. Curr Mol Med, 2005; 5(3): 333339.
16. GuerreMillo M, Rouault C, Poulain P, et al. PPARαnull mice are protected from highfat dietinduced insulin resistance [J]. Diabetes, 2001; 50(12): 28092814.
17. Uranga AP, Levine J, Jensen M. Isotope tracer measures of meal fatty acid metabolism: reproducibility and effects of the menstrual cycle [J]. Am J Physiol Endocrinol Metab, 2005; 288(3): E547E555.
18. Votruba SB, Jensen MD. Sexspecific differences in leg fat uptake are revealed with a highfat meal [J]. Am J Physiol Endocrinol Metab, 2006; 291(5): E1115E1123.
19. Kuhl J, Hilding A, Ostenson CG, et al. Characterisation of subjects with early abnormalities of glucose tolerance in the Stockholm Diabetes Prevention Programme: the impact of sex and type 2 diabetes heredity [J]. Diabetologia, 2005; 48(1): 3540.
20. Laughlin GA, BarrettConnor E, May S. Sexspecific association of the androgen to oestrogen ratio with adipocytokine levels in older adults: the Rancho Bernardo Study [J]. Clin Endocrinol (Oxf), 2006; 65(4): 506513.
21. Lee CC, KasaVubu JZ, Supiano MA. Androgenicity and obesity are independently associated with insulin sensitivity in postmenopausal women [J]. Metabolism, 2004; 53(4): 507512.
22. Livingstone C, Collison M. Sex steroids and insulin resistance [J]. Clin Sci (Lond), 2002; 102(2): 151166.
23. 王治国, 杨喆, 秦环龙, 等. 术前口服碳水化合物改善术后胰岛素抵抗的作用及其机理研究 [J]. 中国普外基础与临床杂志, 2008; 15(11): 799804.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Study of Insulin Resistance for Patients after Selective Operation in Department of General Surgery

Abstract Full text Figures/Tables Video References Cited by

Format

Content