L-arginine On The Effects Of Insulin Resistance And Inflammatory Factors During Cardiopulmonary Bypass

Insulin resistance means a state that insulin in the promotion of tissue glucose uptake and utilization, needing for extraordinary volume than the normal amount of insulin can cause response. The study found, in cardiopulmonary bypass process such as low temperature, low pressure, blood dilution, non-pulsatile perfusion, and anesthesia can cause a strong stress response, resulting in blood glucose, free fatty acids, glycerol and lactic acid concentration increasing, inhibition of insulin in peripheral tissue insulin receptor, insulin receptor substrate -1 and activated protein kinase phosphorylation, and stress also can result in increased adrenocorticotropic hormone and indirectly increase the high blood glucose and insulin resistance [1].With cardiopulmonary bypass cardiac valve replacement under a wide range of conduct, the occurrence of insulin resistance caused wide concern in cardiopulmonary bypass period. Means to control degree of inflammatory reaction help alleviate the insulin resistance [2].L-arginine is an essential amino acids in nitric oxide, creatine, polyamine biosynthesis of the cells ,and plays an important role in the body.L-arginine synthases nitric oxide and citrulline through nitric oxide synthetase. Nitric oxide can lead to strong vascular relaxing, anti-thrombosis, inhibition of vascular smooth muscle proliferation, inhibition of free radical oxidation and neutrophils to endothelial cells,and reducing inflammatory response and cardiac ischemia-reperfusion injury in cardiopulmonary bypass.Purpose: This clinical study of L-arginine in cardiopulmonary bypass, we observe tumor necrosis factor-a, interlukin-6, interlukin-8, insulin resistance.Purpose is to investigate L-arginine effect insulin resistance on during cardiopulmonary bypass and proinflammatory cytokine and explore the role of inflammatory factor .Methods: 40 cases of heart valve replacement patients were randomly divided into two groups before operation:(1) treatment group (A group n = 20),10 minutes before the aorta declamping L-arginine of 100mg/kg is used;(2) control group (B group n = 20),blood sample of the two groups were collected in pre-anesthesia, 15 min after cardiopulmonary bypass ,15 min after the ascending aorta declamping and two hours after weaning off pump. using enzyme-linked immunosorbent assay measure tumor necrosis factor-a,interlukin-6, interlukin-8,insulin,and oxidase method measure blood glucose.Results: The two cases of tumor necrosis factor-a, interlukin-6, interlukin-8 levels were lower before anesthesia, there were no significant differences (P> 0.05); 15 min after cardiopulmonary bypass,ascending aorta declamping and 2 hours after weaning off pump tumor necrosis factor-a,interlukin-6,interlukin-8 levels compared with the preoperative group are significantly higher (P<0.01);15 min after ascending aorta declamping and 2 hours after weaning off pump tumor necrosis factor-a,interlikin-6,interlukin-8 level of A group and B group were significantly lower (P <0.01). Two cases of blood glucose, insulin gradually increased from surgery to 15 min after the ascending aorta declamping and then post-CPB decline slightly, but still higher than the preoperative level. The two groups 15min after CPB, the 15 min after the ascending aorta declamping, 2 hours post-CPB compared with pre- anesthesia the blood glucose level were significantly higher (P <0.01); and the 15 min after the ascending aorta declamping compared with 15 min after CPB was significantly increased (P <0.01).two cases of insulin resistance index was lower before anesthesia, there were no significant differences (P>0.05);15min after cardiopulmonary bypass,15 min after the ascending aorta declamping and two hours after weaning off pump compared with the preoperative were significantly higher (P <0.01);15 min after ascending aorta declamping, 2 hours after weaning off pump the A group is compared to B group and shows a significant decrease (P <0.01).two cases of insulin sensitivity index before anesthesia, there were no significant differences (P>0.05);15min after cardiopulmonary bypass,15 min after the ascending aorta declamping and two hours after weaning off pump compared with the preoperative were significantly lower (P <0.01);15 min after ascending aorta declamping, 2 hours after weaning off pump the A group is compared to B group shows a significantly lower (P <0.01). Proinflammatory cytokine and insulin sensitivity is exitting a passive correlation. Proinflammatory cytokine and insulin resistance is exitting a positive correlation.Conclusion:Through this study can come to following conclusions:1.Cardiopulmonary bypass can cause tumor necrosis factor-a, interlukin-6, interlukin-8 blood Plasma levels to increase.2. Cardiopulmonary bypass can cause hyperglycemia,hyperinsulinemia.2.Cardiopulmonary bypass can deepen degree of insulin resistance.3.L-arginine after cardiopulmonary bypass can reduce Tumor necrosis factor-a, interlukin-6,interlukin-8 level.4.L-arginine can alleviate the degree of insulin resistance.5.Proinflammatory cytokine and insulin sensitivity is exitting a passive correlation6. Proinflammatory cytokine and insulin resistance is exitting a positive correlation...