曲马多对妊娠期糖尿病产妇剖宫产术后胰岛素抵抗的影响

发布时间：2018-05-23 18:09

本文选题：妊娠期糖尿病 + 胰岛素抵抗　；参考：《四川大学学报(医学版)》2017年03期

【摘要】：目的探讨曲马多对妊娠期糖尿病(GDM)产妇剖宫产术后胰岛素抵抗的影响。方法纳入2015年12月至2016年10月在我院行择期剖宫产,且GDM为A1级的产妇120例,随机分为4组,分别为曲马多预处理组TRM1(0.5mg/kg)、TRM2(1mg/kg)、TRM3(1.5mg/kg)和生理盐水对照组(CON组),每组30例。产妇于腰硬联合麻醉下行子宫下段横切口剖宫产术,其中TRM组产妇于胎儿与母体脐带分离即刻分别按质量浓度分组静注盐酸曲马多注射液,CON组则注射同体积生理盐水。于麻醉前(T0)、母婴脐带分离即刻(T1)和术毕即刻(T2)采集外周静脉血,观察各组产妇胰岛素抵抗水平的变化,应用ELISA检测血清中白介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)的表达;于关腹前采集各组产妇的大网膜组织,应用RT-PCR和Western blot检测PI3K/Akt信号通路的活动水平。结果与T_0相比,T_1与T_2时刻各组产妇血糖、胰岛素、胰岛素抵抗指数及炎性因子IL-6和TNF-α的表达均升高,差异有统计学意义(P0.05)。但经曲马多预处理后,于T_2时刻,TRM2和TRM3组的胰岛素抵抗水平及炎性因子水平均较CON组有所改善(P0.05),但TRM1组的上述指标较CON组改善不明显(P0.05)。与CON组相比,TRM2和TRM3组大网膜组织中PI3 K和Akt的基因及蛋白表达水平升高,差异有统计学意义(P0.05)。结论曲马多能降低GDM产妇剖宫产术后胰岛素抵抗水平,其机制可能与降低IL-6和TNF-α的表达及活化PI3K/Akt信号通路干预胰岛素抵抗有关。
[Abstract]:Objective to investigate the effect of tramadol on insulin resistance after cesarean section in women with gestational diabetes mellitus (GDM). Methods from December 2015 to October 2016, 120 cases of elective cesarean section with GDM grade A1 were randomly divided into 4 groups: tramadol preconditioning group (TRM1 + 0.5 mg / kg) and saline control group (Con group, n = 30). Cesarean section of lower segment of uterus was performed under combined spinal-epidural anesthesia. The pregnant women in TRM group were divided into two groups according to their mass concentration: tramadol hydrochloride injection and Con group were injected with the same volume of normal saline immediately after the separation of fetal and maternal umbilical cord. Peripheral venous blood was collected before anesthesia (T0), immediately after umbilical cord separation (T1) and at the end of operation (T2). The changes of insulin resistance were observed. The expression of interleukin-6 (IL-6) and tumor necrosis factor- 伪 (TNF- 伪) in serum were detected by ELISA. RT-PCR and Western blot were used to detect the activity of PI3K/Akt signal pathway. Results compared with T _ 0 and T _ 2, the blood glucose, insulin resistance index and the expression of inflammatory factors IL-6 and TNF- 伪 were increased in all groups (P 0.05). After tramadol preconditioning, the insulin resistance and inflammatory factor levels in both TRM2 and TRM3 groups were better than those in CON group (P 0.05), but the above indexes in TRM1 group were not significantly improved than those in CON group (P 0.05). Compared with CON group, the gene and protein expression of PI3 K and Akt in omentum tissue of TRM3 group and TRM2 group were higher than that of CON group, and the difference was statistically significant (P 0.05). Conclusion Tramadol can decrease the level of insulin resistance after cesarean section with GDM. The mechanism may be related to the decrease of the expression of IL-6 and TNF- 伪 and the intervention of PI3K/Akt signaling pathway in insulin resistance.
【作者单位】：四川大学华西第二医院麻醉科;四川大学华西第二医院出生缺陷与相关妇儿疾病教育部重点实验室;
【分类号】：R614

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