| Objectives:To investigate the relationship between insulin resistance and leptin in the perioperation of cardiac valve replacement.Methods: 20 patients with rheumatic valvular heart disease were treated with cardiac valve replacement using cardiopulmonary bypass since August 2005 to January 2008 . Blood samples were obtained from radial artery at the following intervals: before anesthesia, 2h, 12h, 24h, and 48h after cardiac valve replacement. The concentrations of leptin, insulin and blood glucose were measured. The insulin-sensitivity index[1/(I×G)], insulin-resistance index[(INS x G)/ 22.5] and the ratio of insulin to blood glucose(I/G) were obtained.Results:(1) Insulin,blood glucose and insulin-resistance index increased significantly since the beginning of anesthesia and went to the peak at 24h after cardiac valve replacement (P﹤0.01). 1/(I×G) was lower than that before anesthesia (P﹤0.05)and decreased to the lowest point at 24h after operation. I/G was similar to the preanesthetic level at 2h after operation(P>0.05),and then increased gradually to the peak at 12h after operation, I/G decreased mild during 12h～24h after operation and then increased once more at 48h after operation. (2) Leptin level decreased gradually at the beginning and level at 2h after operation was different significantly as compared with that before anesthesia (P﹤0.05).from then on, leptin began to increase rapidly to the peak at 24h after operation(p<0.01).(3) Leptin concentration correlated well with insulin-resistance index (r=0.958,P=0.010), the correlation between insulin-sensitivity index and insulin-resistance index presented a significant negative correlation (r=-0.922,P= 0.026). Conclusion: (1) Cardiac valve replacement caused a significant increase in insulin- resistance index and blood glucose , which demonstrated an existence of insulin resistance.(2) Correlation between leptin and insulin- resistance index indicates the role of leptin in insulin- resistance.
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