术前输入葡萄糖对胸科手术患者葡萄糖转运蛋白4mRNA基因表达的影响

摘要

Objective: To investigate the changes in glucose transporter-4(Glut-4) mRNA expression in skeletal muscle before and after the thoracic operation and to observe the changes in Glut-4 mRNA expression by preoperative infusion of glucose.Methods: Twelve cases of elective thoracic operation were randomly divided into two groups, namely ordinary group Ⅰ and glucose infusion group Ⅱ. One gram of intercostal muscle was taken while thorax being opened and closed from patients under general anesthesia. Total RNA of the muscle cells was extracted by TRIzol one-step assay. Reverse transcription-competitive polymerase chain reaction (RT-PCR) was used to determine the Glut-4 mRNA amplification products with β-actin mRNA as an internal control. The Glut-4 mRNA expression was expressed by targeted gene/β-actin × 100%. The plasma glucose and insulin levels were determined at the same time. Results: Glut-4 mRNA expression was significantly reduced( P ＜ 0.05) and plasma glucose level increased ( P＜ 0.05), while thorax was being closed as compared with those while being opened. However, Glut-4 mRNA expression in glucose infusion group Ⅱ was significantly higher than ordinary group Ⅰ ( P ＜ 0.01 ) and plasma glucose level in group Ⅱ was lower than group T ( P＜ 0.05) when thorax was being closed. Conclusion: The results indicate that the synthesis of Glut4 is suppressed by the surgical stress of thoracic operation under general anesthesia. We found that preoperative infusion glucose can increase Glut-4 mRNA expression at the same surgical stress and relieve postoperative insulin resistance.%目的:观察术前输入葡萄糖对胸科患者手术前、后肌肉组织Glut4基因mRNA表达的影响.方法:择期食道癌根治手术患者12例,随即分为常规禁食组(Ⅰ组)和输入葡萄糖组(Ⅱ组),分别于进胸和关胸时各取第8肋间骨骼肌1 g,用TRIzol一步法提取肌肉细胞总RNA,通过RT-PCR方法,获得Glut4 mRNA扩增产物;每例表达值以目的基因/β-actin×100%表示,同时测定进胸和关胸时血糖和胰岛素.结果:与进胸时相比较,关胸时Glut4 mRNA表达值均明显降低(P＜0.05),血糖明显升高(P＜0.05);但关胸时Ⅱ组Glut4 mRNA表达值明显高于Ⅰ组(P＜ 0.01).结论:胸科手术后两组骨骼肌Glut4 mRNA表达值明显降低,但输入葡萄糖组Glut4 mRNA表达值下降幅度明显小于常规禁食组Glut4 mR-NA表达值.本结果提示术前输入一定量葡萄糖,可减轻术后Glut4表达受抑制程度,缓解术后胰岛素抵抗现象.