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目的探讨术后胰岛素抵抗程度与血脂水平、胆固醇酯转运蛋白(CETP)TaqIB多态性的相关性。方法86例非糖尿病全身麻醉下择期手术患者,分原发性高血压组(H组)57例和健康对照组(C组)29例。入院后测定血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、空腹血糖(FPG)。分别在麻醉前、术后第1天测定FPG、空腹胰岛素(FINS),并计算胰岛素敏感指数(ISI)。运用PCR-RFLP技术对入选患者进行CETPTaqIB多态性分析。结果H组患者存在空腹高胰岛素血症(P<0.05),血脂特点为高TC、高TG(P<0.05)。H组较C组术后第1天ISI更低(P<0.05)。H组△ISI明显低于C组(P<0.05)。CETPB2B2基因型高血压患者△ISI低于B1等位基因携带者(P<0.05)。结论高血压患者术前存在高胰岛素血症和脂代谢紊乱,手术应激后出现更显著加重的胰岛素抵抗。术后胰岛素抵抗程度与HDL-C、CETPTaqIB多态性有关,B2B2基因型高血压患者术后胰岛素抵抗程度加重。
Objective To investigate the relationship between postoperative insulin resistance and serum lipids, cholesterol ester transfer protein (CETP) TaqIB polymorphism. Methods Totally 86 patients undergoing elective surgery under general anesthesia without diabetes were divided into primary hypertension group (H group) and healthy control group (C group). After admission, serum total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL-C), low density lipoprotein (LDL-C) and fasting blood glucose (FPG) were measured. FPG and fasting insulin (FINS) were measured before anesthesia and on the first postoperative day respectively, and the insulin sensitivity index (ISI) was calculated. CETPTaqIB polymorphism analysis of selected patients using PCR-RFLP technology. Results There was fasting hyperinsulinemia (P <0.05) in group H and high TC and high TG (P <0.05). The ISI of group H was lower than that of group C on the first postoperative day (P <0.05). △ ISI in group H was significantly lower than that in group C (P <0.05). △ ISI in patients with CETPB2B2 genotype was lower than that in subjects with B1 allele (P <0.05). Conclusion Hypertensive patients have hyperinsulinemia and dyslipidemia preoperatively, and more severe insulin resistance appears after surgical stress. Postoperative insulin resistance and HDL-C, CETPTaqIB polymorphism, B2B2-type hypertension patients postoperative insulin resistance worsened.