Effect of surgical stress on plasma glucagon-like peptide 1 level after enternal or parenteral intake of glucose in surgical critically ill patients / 中华临床营养杂志

ABSTRACT

Objective To observe the metabolism characters of plasma glucagon-like peptide 1 (GLP-1) in surgical critical ill patients.Methods Totally 64 selective surgical patients were prospectively enrolled and randomly divided into two groupsenteral nutrition (EN) group (50％ glucose 100 ml orally administered or through nasogastric tube on the next day after operation) and parenteral nutrition (PN) group (50％ glucose 100 ml intravenously infused on the next day after operation).Blood glucose and plasma GLP-1 were determined before operation,after operation,and 0 min,30 min,90 min,and 180 min after the 50％ glucose was used.Then,the EN group was divided into stress hyperglycemia (SH) subgroup and non-stress hyperglycemia (non-SH) subgroup.In both subgroups,plasma tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were detected before operation,after operation,and the next day after operation.Blood glucose,plasma insulin,C-peptide,and GLP-1 were measured before operation,after operation,and 0 min,30 min,90 min,and 180 min after 50％ glucose was used.Results The plasma GLP-1 level (pmol/L) of EN group increased significantly after 50％ glucose was used,and reached the peak at the time of 30 min.In contrast,it did not change in PN group,and were significantly lower than EN group at the time of 30 min [(5.69 ± 2.92) pmol/L vs (33.52 ± 12.32) pmol/L,P ＜0.01] and 90 min [(5.71 ±2.14) pmol/L vs (15.92 ±6.63) pmol/L,P =0.00].Plasma insulin level in SH subgroup were significantly higher than in non-SH group after operation [(18.17±6.18) mU/Lvs (12.10±3.60) mU/L,P=0.01] and30 min [(56.02±14.78) mU/Lvs (43.39±15.60) mU/L,P=0.03] and 90min [(114.58±25.11) mU/Lvs (90.45±25.91) mU/L,P=0.03] after 50％ glucose was used.Plasma C-peptide level in SH subgroup was also significantly higher at the time of 30min [(6.86 ±1.15) μg/L vs (4.76 ± 1.06) μg/L,P=0.04] and 90 min[(12.17 ± 1.96) μg/L vs (9.81 ± 2.35) μg/L,P =0.03] after 50％ glucose was used when compared with non-SH subgroup.Plasma GLP-1 level in SH subgroup was significantly lower than in non-SH group at the time of 30 min [28.76 ± 9.61) pmol/L vs (37.36 ± 10.51) pmol/L,P =0.03] and 90 min [(13.49±4.26) pmol/Lvs (17.33±5.57) pmoL/L,P=0.04] after 50％ glucose was used.Conclusions Early post-operative PN increases plasma GLP-1 level and reduces the SH incidence.In SH patients,endogenous insulin expression increases while plasma GLP-1 level decreases.Post-surgery inflammatory reaction may result in low plasma GLP-1 level and high blood glucose level.