DOI QR코드

DOI QR Code

Effect of Intraoperative Glucose Fluctuation and Postoperative IL-6, TNF-α, CRP Levels on the Short-term Prognosis of Patients with Intracranial Supratentorial Neoplasms

  • Liu, Tie-Cheng (Department of Anesthesiology, The Second Hospital of Jilin University) ;
  • Liu, Qi-Ran (Medical College, Yanbian University) ;
  • Huang, Ying (Department of Internal Medicine, Changchun Hospital of Kuancheng District)
  • Published : 2015.01.22

Abstract

Objective: To investigate the effect of intraoperative glucose fluctuation and postoperative interlukin-6 (IL-6), tumor necrosis factor-${\alpha}$ (TNF-${\alpha}$), C-reactive protein (CRP) levels on the short-term prognosis of patients with intracranial supratentorial neoplasms. Materials and Methods: Eighty-six patients undergoing intracranial excision were selected in The Second Hospital of Jilin University. According to the condition of glucose fluctuation, the patients were divided into group A (glucose fluctuation <2.2 mmol/L, n=57) and group B (glucose fluctuation ${\geq}2.2mmol/L$, n=29). Glucose was assessed by drawing 2 mL blood from internal jugular vein in two groups in the following time points, namely fasting blood glucose 1 d before operation ($T_0$), 5 min after anesthesia induction ($T_1$), intraoperative peak glucose ($T_2$), intraoperative lowest glucose ($T_3$), 5 min after closing the skull ($T_4$), immediately after returning to intensive care unit (ICU) ($T_5$) and 2 h after returning to ICU ($T_6$). 1 d before operation and 1, 3 and 6 d after operation, serum IL-6 and TNF-${\alpha}$ levels were detected with enzyme-linked immunosorbent assay (ELISA), and CRP level with immunoturbidimetry. Additionally, postoperative adverse reactions were monitored. Results: There was no statistical significance between two groups regarding the operation time, anesthesia time, amount of intraoperative bleeding and blood transfusion (P>0.05). The glucose levels in both groups at $T_1{\sim}T_6$ went up conspicuously compared with that at $T_0$ (P<0.01), and those in group B at $T_2$, $T_4$, $T_5$ and $T_6$ were significantly higher than in group A (P<0.01). Serum IL-6, TNF-${\alpha}$ and CRP levels in both groups 1, 3 and 6 d after operation increased markedly compared with 1 d before operation (P<0.01), but the increased range in group A was notably lower than in group B (P<0.05 or P<0.01). Postoperative incidences of hypoglycemia, hyperglycemia and myocardial ischemia in group A were significantly lower than in group B (P<0.05), and respiratory support time obviously shorter than in group B (P<0.01). Conclusions: The glucose fluctuation of patients undergoing intracranial excision is related to postoperative IL-6, TNF-${\alpha}$ and CRP levels and those with small range of glucose fluctuation have better prognosis.

References

  1. ANeutrophil function and metabolism in individuals with diabetes mellitus. Braz J Med Biol Res, 40, 1037-44.
  2. Atkins JH, Smith DS (2009). A review of perioperative glucose control in the neurosurgical population. J Diabetes Sci Technol, 3, 1352-64. https://doi.org/10.1177/193229680900300615
  3. El-Hussuna A, Krag A, Olaison G, et al (2013). The effect of anti-tumor necrosis factor alpha agents on postoperative anastomotic complications in Crohn's disease: a systematic review. Dis Colon Rectum, 56, 1423-33. https://doi.org/10.1097/DCR.0b013e3182a48505
  4. Franca EL, Franca-Botelho Ado C, Franca JL, et al (2014). Repercussions of breastfeeding by diabetic women for breast cancer. Asian Pac J Cancer Prev, 14, 6233-9.
  5. Gugapriya TS, Karthick S, Nagarjuna B (2014). A prospective study of variability in glycemic control during different phases of the menstrual cycle in type 2 diabetic women using high sensitivity C-reactive protein. J Clin Diagn Res, 8, CC01-4. https://doi.org/10.1111/crj.12028
  6. Holmer R, Goumas FA, Waetzig GH, et al (2014). Interleukin-6: a villain in the drama of pancreatic cancer development and progression. Hepatobiliary Pancreat Dis Int, 13, 371-80. https://doi.org/10.1016/S1499-3872(14)60259-9
  7. Hotamisligil GS, Spiegelman BM (1994). Tumor necrosis factor alpha: a key component of the obesity-diabetes link. Diabetes, 43, 1271-8.
  8. Mazze R, Yogev Y, Langer O (2012). Measuring glucose exposure and variability using continuous glucose monitoring in normal and abnormal glucose metabolism in pregnancy. J Matern Fetal Neonatal Med, 25, 1171-5. https://doi.org/10.3109/14767058.2012.670413
  9. Miyake Y (2014). Management of hyperglycemic crises and severe hypoglycemia in the emergency department. Brain Nerve, 66, 97-105.
  10. Nishimura F, Takahashi K, Kurihara M, et al (1998). Periodontal disease as a complication of diabetes mellitus. Ann Periodontol, 3, 20-9.
  11. Rassias AJ (2006). Intraoperative management of hyperglycemia in the cardiac surgical patient. Semin Thorac Cardiovasc Surg, 18, 330-8. https://doi.org/10.1053/j.semtcvs.2006.05.002
  12. Rassias AJ, Givan AL, Marrin CA, et al (2002). Insulin increases neutrophil count and phagocytic capacity after cardiac surgery. Anesth Analg, 94, 1113-9. https://doi.org/10.1097/00000539-200205000-00010
  13. Teraguchi I, Imanishi T, Ozaki Y, et al (2014). Acute-phase glucose fluctuation is negatively correlated with myocardial salvage after acute myocardial infarction. Circ J, 78, 170-9.
  14. Tripsianis G, Papadopoulou E, Romanidis K, et al (2013). Overall survival and clinicopathological characteristics of patients with breast cancer in relation to the expressionpattern of HER-2, IL-6, $TNF-{\alpha}$ and $TGF-{\beta}1$. Asian Pac J Cancer Prev, 14, 6813-20. https://doi.org/10.7314/APJCP.2013.14.11.6813
  15. Wang JS, Yin HJ, Guo CY, et al (2013). Influence of high blood glucose fluctuation on endothelial function of type 2 diabetes mellitus rats and effects of Panax Quinquefolius Saponin of stem and leaf. Chin J Integr Med, 19, 217-22. https://doi.org/10.1007/s11655-012-1093-z
  16. Watada H, Azuma K, Kawamori R (2007). Glucose fluctuation on the progression of diabetic macroangiopathy--new findings from monocyte adhesion toendothelial cells. Diabetes Res Clin Pract, 77 Suppl 1, S58-61. https://doi.org/10.1016/j.diabres.2007.01.034
  17. Wu D, Gong CX, Meng X, et al (2013). Correlation between blood glucose fluctuations and activation of oxidative stress in type 1 diabetic children during the acute metabolic disturbance period. Chin Med J, 126, 4019-22.
  18. Yu Q, Yu XF, Zhang SD, et al (2013). Prognostic role of C-reactive protein in gastric cancer: a meta-analysis. Asian Pac J Cancer Prev, 14, 5735-40. https://doi.org/10.7314/APJCP.2013.14.10.5735