Effect Of Intensive Insulin Therapy On The End Points Of Postoperative Patients With Gastric Cancer.

Objective To investigate the influence of intensive insulin therapy on the end points of postoperative patients with gastric cancer,and to explore the underlying anti-inflammatory mechanism of intensive insulin therapy.Methods Eligible patients with gastric cancer underwent radical operation were randomly divided into two groups: intensive group(n=23 and maintenance of blood glucose at a level between 4.4 and 6.1mmoL/L) and conventional group(n=23 and maintenance of blood glucose at a level between 10 and 11.1mmoL/L). Fasting blood glucose(FBG),fasting insulin(FINS),interleukin-1β(IL-1β),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α) and C reaction protein(CRP) in 46 patients were detected dynamically during perioperative period.Insulin resistance index(HOMA-IR) were calculated using Hemeostasis Model Assessment(HOMA) to evaluate insulin sensitivity.The correlations between HOMA-IR and IL-1β, IL-6,TNF-αwere analyzed.Postoperative complications and other clinical data were record.Results Hypoglycemia did not occur in patients of both groups.The average blood glucose level of patients in intensive group(5.5±0.5) mmol/L was obviously lower than that in conventional group(10.5±0.4) mmol/L(P=0.000).HOMA-IR was positively correlated with IL-1β,IL-6,TNF-α.On postoperative first day and third day,HOMA-IR and serum levels of IL-1β,IL-6,TNF-αand CRP in patients of intensive group were significantly lower than those in patients of conventional group(P＜0.05).Compared with conventional group, intensive group reduced morbidity and postoperative duration of fever, antibiotic use and the length of hospital stay(P＜0.05).Conclusions Intensive insulin therapy is safe if acted strictly according to glycemia controlling protocol.The cytokines IL-1β,IL-6 and TNF-αhave a close correlation with operation-induced insulin resistance.Intensive insulin therapy may play an important role in counteracting the high-inflammatory of postoperative patients.The anti-inflammatory actions of insulin,as well as its glycemia controlling effects,might contribute to the improved outcomes of postoperative patients.