The Effect Of Intensive Insulin Therapy On The Insulin Resistance In Postoperative Gastric Cancer Patients Underwent Different Nutritional Supports

Objective To investigate the influence of intensive insulin therapy with different nutritional supports on resting energy expenditures,insulin resistance,stress index and outcome parameters in postoperative gastic cancer patients.Methods 104 gastric cancer patients enrolled in our department from April 2007 to October 2008 were randomly divided into 3 groups(PN group,n=34;EN group n=34;PN+EN group,n=34),that each group could be relatively classified into intensive insulin therapy group(level of blood glucose between 4.4～6.1mmol/L) and control group(conventional treat group,level of blood glucose between 6.1～11.1mmol/L) while nutritional support.After operation,the level of fasting blood glucose(FBG),fasting insulin(FINS),C-reactive protein(CRP),Inflammatory mediators(interleukin-6,IL-6 and tumor necrosis factor-α,TNF-α),were assayed on preoperative day and on the postoperatively lst,3rd and 7th day respectively;and resting energy expenditure(REE) was measured by indirect calorimetry in the morning.Furthermore,insulin resistance index was calculated using homeostasis model assessment(HOMA),and postoperative complications and outcome parameters were recorded respectively.Results 1.In the three nutritional support groups,REE on the postoperative 1^st and 3^rd day in the intensive insulin therapy group were significant lower than that in the conventional group;on the postoperative 3^rd day,in the conventional group and the intensive insulin therapy group,the REE in PN group were signifcant higher than those both in EN group and PN+EN group(the conventional group p=0.026,p=0.044; the intensive insulin therapy group p=0.018,p=0.043);2.In the three nutritional support groups,CRP,TNF-α,FBG,FINS,INHOMA-IR and the rate of insulin resistance on the postoperative 1^st,3^rd and 7^th day in the intensive insulin therapy group were significant lower than those in the control group; while TNF-a on the postoperative 1^st and 3^rd day in the intensive insulin therapy group were significant lower than that in the control group.There were the positive correlation between INHOMA-IR and CRP,IL-6,TNF-αin the 6 groups(p<0.05);3.In the three nutritional support groups,the total infectious complication rate in the intensive insulin therapy were significant lower than that in control group;The duration of fever,antibiotic use,passage of gas by anus,the length of hospital stay, the cost in hospital were also significantly lower than those in control group(p< 0.05).Conclusions 1.The intensive insulin therapy can reduce the insulin resistance of postoperative gastric cancer patients underwent different nutritional supports,improve the patients' outcome;2.Compared with parenteral nutrition,enteral nutrition can decrease the insulin resistance remarkly;3.The intensive insulin therapy may contribute to the decrease of REE and the inhibition of inflammatory mediators.