The Study Of Insulin Resistance On Postoperative Patients With Gastric Cancer

Objective Surgical trauma, as a stressor, may cause insulin resistance (IR),and insulin resistance may cause metabolic disorder due to abnormalphysiologic functions of insulin. The purpose of this study is to observe theepidemiological features and clinical significance of insulin resistance inpostoperative patients with gastric cancer, and to evaluate the relationshipbetween insulin resistance and clinical parameters, and to investigate theinfluence of insulin resistance on metabolism. Methods 51 patients withgastric cancer were selected randomly to measure body anthropometry andbody composition by dual-energy X-ray absorptiometry (DEXA) afterhospitalization. Fasting blood glucose (FBG) and fasting insulin (FINS) weredetected preoperatively and on the 1st day postoperatively, visceral proteinsand immunologic index including albumin (ALB), prealbumin (PRE),transferring (TRF), retinal-binding protein(RBP), IgG, IgA, IgM, C₃ and C₄were measured preoperatively, on the 1st and 8ed day postoperatively.Postoperative complications was recorded. Insulin resistance was evaluatedby the method of homeostasis model assessment (HOMA). Results (1) Theincidence of IR in gastric cancer patients was 49.02% postoperatively,lnHOMA-IR was positively correlated with patients' weight, BMI, waistcircumference, hip circumference, waist to hip ratio (WHR) and body fat.FINS, FBG and waist circumference were independently positivelycorrelated with InHOMA-IR, the R² of the equations was 0.879. The multiplefactors Logistic regression showed that waist circumference was correlatedwith IR in this model, and the accuracy was 72.5%. (2) There was asignificant difference among the levels of albumin and insulin preoperativelyand the levels of albumin, insulin and glucose on the 1st day postoperativelybetween the IR group and non-IR group. Both albumin and transfferin didn'treturn to preoperative level in patients with IR on the 8ed daypostoperatively, while only albumin was restored in patients with non-IR onthe 8ed day postoperatively. (3) The postoperative complication incidence between the IR and non-IR patients was 44.0% and 11.5% individually, therewas a obvious difference between them. (4) The incidenc of IR between theabdominal obesity and non-abdominal obesity was 73.7% and 34.4%respectively, there was an apparent difference between these two groups.Conclusions (1) Insulin resistance was existed in gastric cancerpostoperatively, lnHOMA-IR was positively correlated with weight, BMI,waist circumference, hip circumference, WHR and body fat. (2) IR mayinduce metabolic disorder such as hyperglycemia and protein synthesisdefect, especially on transfferin which was regarded as the marker of proteinsyntheses during insulin resistance. (3) The incidence of postoperativecomplication was higher in IR patients than non-IR group.